Fredericka Lynette Fairman

Primary specialty

Nurse's AideTaxonomy code 376K00000X

License

083949 Issued in MS

Practice address

504 Eastgate Dr
Brookhaven, MS 39601-3106

Phone

(601) 748-1731

NPI assigned

Dec 10, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1733788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735689600000",
    "number": "1679389944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 EASTGATE DR",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396013106",
            "telephone_number": "601-748-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 EASTGATE DR",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396013106",
            "telephone_number": "601-748-1731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRMAN",
        "first_name": "FREDERICKA",
        "middle_name": "LYNETTE",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-10",
        "last_updated": "2025-01-01",
        "certification_date": "2025-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "MS",
            "license": "083949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Graves Eubanks
• Tamika Evans
• Extended Care Clinical Services LLC (Extended Care Clinical Services)
• F Lee Neal Jr MD PA
• Faces and Voices of Recovery Mississippi (mississippi recovery community organization collaborative)
• Family Health Care Clinic, Inc
• Amanda Farish
• First Care Home Heath Agency LLC
• Courtney Fleming
• Katherine Ross Flynn, PMHNP-BC

• Nurse's Aide in Brookhaven, MS
• Providers in Brookhaven, MS by specialty
• Nurse's Aide in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2025; 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.