Provider Demographics
NPI:1275253353
Name:FIELDS, NIKIESHA LISETTE
Entity Type:Individual
Prefix:
First Name:NIKIESHA
Middle Name:LISETTE
Last Name:FIELDS
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 1:11553 OLD 125 RD
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND NECK
Mailing Address - State:NC
Mailing Address - Zip Code:27874-9242
Mailing Address - Country:US
Mailing Address - Phone:252-883-1491
Mailing Address - Fax:
Practice Address - Street 1:11553 OLD 125 RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-9242
Practice Address - Country:US
Practice Address - Phone:252-883-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000009988103347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle