Provider Demographics
NPI:1962867325
Name:FIELDS, TOMMIE LEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TOMMIE
Middle Name:LEE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:TOMMIE
Other - Middle Name:LEE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73 THOMPSON POYNTER RD STE A
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-7202
Mailing Address - Country:US
Mailing Address - Phone:606-877-1446
Mailing Address - Fax:606-877-1285
Practice Address - Street 1:73 THOMPSON POYNTER RD STE A
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7202
Practice Address - Country:US
Practice Address - Phone:606-877-1446
Practice Address - Fax:606-877-1285
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009981363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3009981OtherMEDICAID