Provider Demographics
NPI:1760857163
Name:FIELDS, CASSANDRA (APRN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:SUE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1889
Mailing Address - Country:US
Mailing Address - Phone:859-523-2526
Mailing Address - Fax:859-523-2532
Practice Address - Street 1:151 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 320
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1889
Practice Address - Country:US
Practice Address - Phone:859-523-2526
Practice Address - Fax:859-523-2532
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009934363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3009934OtherLICENSE
KY7100378890Medicaid
KY7100378890Medicaid