Provider Demographics
NPI:1932124864
Name:FIELDS, PAMELA K (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:FIELDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-337-0777
Mailing Address - Fax:208-377-1070
Practice Address - Street 1:6165 W EMERALD STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8613
Practice Address - Country:US
Practice Address - Phone:208-377-0777
Practice Address - Fax:208-377-0777
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN21384163W00000X
IDNP-498A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13432441Medicare PIN
IDP34031Medicare UPIN
ID13432441Medicare PIN
ID000010169736OtherREGENCE BLUESHIELD
ID185389500OtherUS DEPT OF LABOR
ID805928000Medicaid