Provider Demographics
NPI:1275404188
Name:FAIRLEY, LE'BRIANNA
Entity type:Individual
Prefix:
First Name:LE'BRIANNA
Middle Name:
Last Name:FAIRLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 DORRIE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-2321
Mailing Address - Country:US
Mailing Address - Phone:901-834-6711
Mailing Address - Fax:
Practice Address - Street 1:3747 DORRIE CIR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-2321
Practice Address - Country:US
Practice Address - Phone:901-834-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program