Provider Demographics
NPI:1679217996
Name:FIELDS, SHELBY KING (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:KING
Last Name:FIELDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:FAITH
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1527 CLEVELAND AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5199
Mailing Address - Country:US
Mailing Address - Phone:205-222-3910
Mailing Address - Fax:
Practice Address - Street 1:125 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1601
Practice Address - Country:US
Practice Address - Phone:704-827-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC317733163W00000X
NC5019543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse