Provider Demographics
NPI:1851800148
Name:FAIR, JOSELYN ELISE (FNP)
Entity type:Individual
Prefix:
First Name:JOSELYN
Middle Name:ELISE
Last Name:FAIR
Suffix:
Gender:
Credentials:FNP
Other - Prefix:MS
Other - First Name:JOSELYN
Other - Middle Name:ELISE
Other - Last Name:FAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-791-2203
Mailing Address - Fax:
Practice Address - Street 1:103 SUMMIT CENTRE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7613
Practice Address - Country:US
Practice Address - Phone:803-382-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner