Individual provider Active NPI

Christal Sareda Fairley, NP

  • Family Nurse Practitioner
  • Ocean Springs, MS
National Provider Identifier
1073180063
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
904675 Issued in MS
Practice address
3099 Bienville Blvd
Ocean Springs, MS 39564-4308
Phone
(228) 872-2403
NPI assigned
Jun 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 904675 MS Primary

Addresses

Primary practice location

3099 Bienville Blvd
Ocean Springs, MS 39564-4308

Mailing address

118 Streets LN
Lucedale, MS 39452-9447
Phone (601) 530-9099

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210624000164 MS Practitioner - Nurse Practitioner 6103227400 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

967 Cedar Lake Rd
Biloxi, MS 39532-2128
Phone (228) 205-6814

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
904675MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Health System CurrentSince Jul 21, 2021 Accepting new patients
Singing River Gulfport CurrentSince Jul 21, 2021 Accepting new patients
Singing River Health System Past Accepting new patients

Locations

967 Cedar Lake Rd
Biloxi, MS 39532
Phone (228) 205-6814

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

3099 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 872-2403

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1073180063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 STREETS LN",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394529447",
            "telephone_number": "601-530-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3099 BIENVILLE BLVD",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395644308",
            "telephone_number": "228-872-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRLEY",
        "first_name": "CHRISTAL",
        "middle_name": "SAREDA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean Springs, MS

Sources for this page

Verify at the official NPI Registry.