Provider Demographics
NPI:1194866400
Name:FIELDS, BETTY CAROL (LPN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:CAROL
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 1:435 OLD STAGE RD
Mailing Address - Street 2:APT. 7
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-3435
Mailing Address - Country:US
Mailing Address - Phone:423-416-1748
Mailing Address - Fax:
Practice Address - Street 1:247 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:TN
Practice Address - Zip Code:37642-3516
Practice Address - Country:US
Practice Address - Phone:423-357-5341
Practice Address - Fax:423-357-2231
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000011561164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse