Provider Demographics
NPI:1962090340
Name:WESTER, FAIRYN MARISSA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:FAIRYN
Middle Name:MARISSA
Last Name:WESTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:FAIRYN
Other - Middle Name:MARISSA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4606 KAMI DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7053
Mailing Address - Country:US
Mailing Address - Phone:903-818-1949
Mailing Address - Fax:
Practice Address - Street 1:505 E MATTHEWS AVE STE 303
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3101
Practice Address - Country:US
Practice Address - Phone:870-932-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214846367500000X
TX859470163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse