Provider Demographics
NPI:1265775712
Name:FIELDS, JENNIFER D (CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JENNIFFER
Other - Middle Name:D
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1049 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1104
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:201 MIDWAY DR.
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:WV
Practice Address - Zip Code:25265
Practice Address - Country:US
Practice Address - Phone:740-416-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14567-NP363LF0000X
OHRN.277992390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0087008Medicaid
OHH217810Medicare PIN
OHH217810Medicare PIN