Provider Demographics
NPI:1003355884
Name:FIELDS, KIMBER (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBER
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-3249
Mailing Address - Country:US
Mailing Address - Phone:770-748-1500
Mailing Address - Fax:
Practice Address - Street 1:740 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-3249
Practice Address - Country:US
Practice Address - Phone:770-748-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN085201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse