Provider Demographics
NPI:1497239487
Name:FIELDS, LADINA R (FNP)
Entity Type:Individual
Prefix:
First Name:LADINA
Middle Name:R
Last Name:FIELDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 PROSPERITY LN STE 204
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3743
Mailing Address - Country:US
Mailing Address - Phone:304-792-7130
Mailing Address - Fax:304-896-5184
Practice Address - Street 1:184 E 2ND AVE STE 210
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3602
Practice Address - Country:US
Practice Address - Phone:304-236-5902
Practice Address - Fax:855-487-4047
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVAPRN63067-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily