Provider Demographics
NPI:1104054410
Name:FAIRCHILD, KENT JOSEPH (RN)
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:JOSEPH
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MADERA CT
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3140
Mailing Address - Country:US
Mailing Address - Phone:504-460-3271
Mailing Address - Fax:
Practice Address - Street 1:19 MADERA CT
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3140
Practice Address - Country:US
Practice Address - Phone:504-460-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA088834163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical