Provider Demographics
NPI:1073059945
Name:FIELDER FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:FIELDER FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:337-886-1200
Mailing Address - Street 1:503 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-3119
Mailing Address - Country:US
Mailing Address - Phone:337-886-1200
Mailing Address - Fax:337-886-0919
Practice Address - Street 1:503 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3119
Practice Address - Country:US
Practice Address - Phone:337-886-1200
Practice Address - Fax:337-886-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN130981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty