Provider Demographics
NPI:1639832421
Name:FIELDS, KIMMESHRANDA
Entity Type:Individual
Prefix:
First Name:KIMMESHRANDA
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 1:3648 CYPRESS CREEK PKWY STE 121B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3609
Mailing Address - Country:US
Mailing Address - Phone:314-755-9653
Mailing Address - Fax:
Practice Address - Street 1:3648 CYPRESS CREEK PKWY STE 121B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3609
Practice Address - Country:US
Practice Address - Phone:314-755-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator