Provider Demographics
NPI:1578688024
Name:FIELDS, KIMBERLY (ANP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10943 PRAIRIE HAWK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-7765
Mailing Address - Country:US
Mailing Address - Phone:703-439-6000
Mailing Address - Fax:
Practice Address - Street 1:2223 WEST LOOP S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3588
Practice Address - Country:US
Practice Address - Phone:713-439-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX582354OtherSTATE LICENSE NUMBER