Provider Demographics
NPI:1396498846
Name:FIELDS, COURTNEY D
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:D
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 WOODSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-8881
Mailing Address - Country:US
Mailing Address - Phone:804-836-4606
Mailing Address - Fax:
Practice Address - Street 1:4424 WOODSTREAM DR
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-8881
Practice Address - Country:US
Practice Address - Phone:804-836-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0Medicaid