Provider Demographics
NPI:1295032746
Name:FIELDS, JENNIFER KOLYNDRA (FNP-C, PMHNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KOLYNDRA
Last Name:FIELDS
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:CLEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:120 SAINT ALBANS DR APT 657
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5892
Mailing Address - Country:US
Mailing Address - Phone:704-906-9317
Mailing Address - Fax:704-384-0561
Practice Address - Street 1:5109 BUR OAK CIR STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3101
Practice Address - Country:US
Practice Address - Phone:919-275-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005086363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health