Provider Demographics
NPI:1922599893
Name:FAIR, JO (ANP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:FAIR
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 DONELSON PIKE STE 395
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3563
Mailing Address - Country:US
Mailing Address - Phone:615-367-1444
Mailing Address - Fax:615-367-1445
Practice Address - Street 1:7735 FARMINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2901
Practice Address - Country:US
Practice Address - Phone:901-757-6805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty