Provider Demographics
NPI:1942432083
Name:FIELDS, LARRY KYLE (LPN)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:KYLE
Last Name:FIELDS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 LEO DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-5211
Mailing Address - Country:US
Mailing Address - Phone:513-255-1994
Mailing Address - Fax:
Practice Address - Street 1:510 LEO DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-5211
Practice Address - Country:US
Practice Address - Phone:513-255-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.133642-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse