Provider Demographics
NPI:1891083630
Name:KARANA R. FAIRLEY, M.D., P.A.
Entity Type:Organization
Organization Name:KARANA R. FAIRLEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-867-9300
Mailing Address - Street 1:3801 W 15TH ST STE 350B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7723
Mailing Address - Country:US
Mailing Address - Phone:972-867-9300
Mailing Address - Fax:972-867-1700
Practice Address - Street 1:3801 W 15TH ST STE 350B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7723
Practice Address - Country:US
Practice Address - Phone:972-867-9300
Practice Address - Fax:972-867-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty