Provider Demographics
NPI:1194077016
Name:FAIRCHILD, ARVON CLYDE JR
Entity type:Individual
Prefix:MR
First Name:ARVON
Middle Name:CLYDE
Last Name:FAIRCHILD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:FAIRCHILD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:CCN
Mailing Address - Street 1:723 HILL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5904
Mailing Address - Country:US
Mailing Address - Phone:830-896-0550
Mailing Address - Fax:830-896-9501
Practice Address - Street 1:723 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5904
Practice Address - Country:US
Practice Address - Phone:830-896-0550
Practice Address - Fax:830-896-9501
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education