Clifford W Fawcett III, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP 10074 Issued in OH

Practice address

888 Dayton St
Suite 200
Yellow Springs, OH 45387-1777

Phone

(937) 767-7291

Fax

(937) 767-1302

NPI assigned

Jul 12, 2006

Last updated

Nov 13, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447372800000",
    "number": "1184649337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 DAYTON ST",
            "address_2": "SUITE 200",
            "city": "YELLOW SPRINGS",
            "state": "OH",
            "postal_code": "453871777",
            "telephone_number": "937-767-7291",
            "fax_number": "937-767-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 DAYTON ST",
            "address_2": "SUITE 200",
            "city": "YELLOW SPRINGS",
            "state": "OH",
            "postal_code": "453871777",
            "telephone_number": "937-767-7291",
            "fax_number": "937-767-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAWCETT",
        "first_name": "CLIFFORD",
        "middle_name": "W",
        "name_suffix": "III",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2015-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "UP004512B",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "NP 10074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3108872",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Patricia Gerrior, SLP

• Family Nurse Practitioner in Yellow Springs, OH
• Providers in Yellow Springs, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.