Provider Demographics
NPI:1659041572
Name:FIELDS, CHOLOTTIE JANE (ISSA- CPT)
Entity Type:Individual
Prefix:
First Name:CHOLOTTIE
Middle Name:JANE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:ISSA- CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 WINCHESTER RD STE 5
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-3948
Mailing Address - Country:US
Mailing Address - Phone:859-270-7468
Mailing Address - Fax:
Practice Address - Street 1:952 WINCHESTER RD STE 5
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3948
Practice Address - Country:US
Practice Address - Phone:859-270-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ991169390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program