Provider Demographics
NPI:1578532529
Name:FIELDS, N CAROL (PA)
Entity Type:Individual
Prefix:MRS
First Name:N
Middle Name:CAROL
Last Name:FIELDS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14855 BLANCO RD
Mailing Address - Street 2:STE 214
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7732
Mailing Address - Country:US
Mailing Address - Phone:210-493-1568
Mailing Address - Fax:210-493-8345
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:STE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-614-0402
Practice Address - Fax:210-614-2838
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03603363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A9313Medicare ID - Type Unspecified
S69608Medicare UPIN