Joanne Fairley, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

281478 Issued in AZ

Practice address

14116 Customs Blvd
Gulfport, MS 39503-5164

Phone

(601) 957-6300

NPI assigned

Jun 13, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Prof. Joanna Fairley Professional name

Medicare fee-for-service enrollment

Enrolled in MS, TN2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Systems Management, LLCGroup PAC ID 5092964643, 49 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jfairley@landmarkhealth-direct.org
• Direct secure messaging: ms_jfairle3@landmarkhealth-direct.org

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.

• Medical Systems Management LLC

  • Rural Health Clinic/Center
  • Richland, MS
  • NPI 1740555267

  MS

  Medicare reassignment Care Compare group NPD
• Landmark Medical of Tennessee PC

  • General Practice Physician
  • Brentwood, TN
  • NPI 1396498143

  TN

  Medicare reassignment NPD
• Landmark Health of Oregon LLC

  • General Practice Physician
  • Tigard, OR
  • NPI 1205226214
  NPD (past)
• Summit Medical Group, PLLC

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1699722470
  NPD (past)

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

{
    "created_epoch": "1434153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1972984136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7755 CENTER AVE",
            "address_2": "STE 630",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926479152",
            "telephone_number": "657-400-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14116 CUSTOMS BLVD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395035164",
            "telephone_number": "601-957-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4201 Coventry Dr",
            "address_purpose": "LOCATION",
            "city": "Moss Point",
            "state": "MS",
            "postal_code": "395628026",
            "country_code": "US",
            "telephone_number": "228-235-3173",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Galleria Blvd # 1420",
            "address_purpose": "LOCATION",
            "city": "Metairie",
            "state": "LA",
            "postal_code": "700012082",
            "country_code": "US",
            "telephone_number": "833-362-5364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRLEY",
        "first_name": "JOANNE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-13",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R781853",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "R781853",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "281478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOANNA",
            "last_name": "FAIRLEY",
            "prefix": "PROF.",
            "credential": "PHD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Eyemart Express LTD
• Caira D Fairley
• Crystal Tamika Fairley
• Eloise Antoinette Fairley
• Jessika Fairley
• Tia Fairley
• Fairy Wings Mobile Phlebotomy Service LLC
• Kali Falnes
• Family Clinic,PLLC
• Gail Farrar I, M.D.

• Nurse Practitioner in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.