Provider Demographics
NPI:1669834230
Name:FIELDS, JESSICA CAROL (PTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAROL
Last Name:FIELDS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 COBBLE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7917
Mailing Address - Country:US
Mailing Address - Phone:615-970-1441
Mailing Address - Fax:
Practice Address - Street 1:3413 COBBLE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-7917
Practice Address - Country:US
Practice Address - Phone:615-970-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6139225200000X
KYA02535225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant