Provider Demographics
NPI:1306828181
Name:FIELDS, KELLY A (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 A ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4283
Mailing Address - Country:US
Mailing Address - Phone:402-489-7100
Mailing Address - Fax:402-489-3249
Practice Address - Street 1:7111 A ST STE 201
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4283
Practice Address - Country:US
Practice Address - Phone:402-489-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110241363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES47150Medicare ID - Type Unspecified
NE269843F1Medicare UPIN