| NPI | 1063543890 |
|---|---|
| NPI Type | NPI-1 Individual |
| Status | Active |
| Enumeration Date | 2007-03-07 |
| Last Updated | 2020-09-10 |
| Mailing Address | 550 Redstone Ave W Ste 460 Crestview, FL 32536-6428 United States Phone: (205) 454-2022 | Fax: (850) 398-8727 📍 View Map |
| Primary Practice Address | 127 E Redstone Ave Ste C Crestview, FL 32539-5356 United States Phone: (850) 423-0061 | Fax: (850) 423-9954 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | GA | 000946547B | — |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 363LF0000X – Nurse Practitioner, Family | GA | 0103219 |
| Yes | 363LF0000X – Nurse Practitioner, Family | FL | ARNP9470257 |
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About NPI 1063543890
John Myron Faircloth NP is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1063543890. The primary specialty listed is Nurse Practitioner, Family. The provider is located in Crestview, FL. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2007-03-07. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1063543890?
NPI 1063543890 belongs to John Myron Faircloth NP, a Nurse Practitioner, Family in Crestview, FL. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.
Is NPI 1063543890 active?
The current status of NPI 1063543890 in the NPPES registry is Active. The record was last updated on 2020-09-10.
What specialty is NPI 1063543890?
NPI 1063543890 is classified under the taxonomy Nurse Practitioner, Family. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1063543890?
You can verify NPI 1063543890 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1063543890?
The primary practice address on file for NPI 1063543890 is 127 E Redstone Ave Ste C, Crestview, FL 32539-5356. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1063543890 issued?
NPI 1063543890 was first issued (enumerated) on 2007-03-07. The NPPES record was last updated on 2020-09-10.
Practice Location Map
John Myron Faircloth is located at 127 E Redstone Ave Ste C, Crestview, FL. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as John Myron Faircloth. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1063543890. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Nurse Practitioner, Family | 0103219 | GA |
| Nurse Practitioner, Family | ARNP9470257 | FL |