Provider Demographics
NPI:1346537271
Name:FIELDS, KAYLA
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
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 1:640 W HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769
Mailing Address - Country:US
Mailing Address - Phone:606-765-6080
Mailing Address - Fax:606-549-2855
Practice Address - Street 1:640 W HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769
Practice Address - Country:US
Practice Address - Phone:606-765-6080
Practice Address - Fax:606-549-2855
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9042OtherSTATE LICENSE
KY7100191350Medicaid
KY7100191350Medicaid