Basic Information
| Provider Information | |||||||||
| NPI: | 1609169499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAIRCHILD | ||||||||
| FirstName: | TRICIA | ||||||||
| MiddleName: | LYN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FAIRCHILD | ||||||||
| OtherFirstName: | TRICIA | ||||||||
| OtherMiddleName: | LYB | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 600 NW MURRAY RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640811245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165242626 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1345 W CENTRAL PARK AVE | ||||||||
| Address2: | FAMILY MEDICINE RESIDENCY PROGRAM | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528041844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634214400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | R-9144 | IA | N | Allopathic & Osteopathic Physicians | Urology | 207Q00000X | R-09884 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.