Provider Demographics
NPI:1700069887
Name:FIELDS, HEATHER LACONYA VEAL (CRNA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LACONYA VEAL
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:VEAL
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 661495
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-1495
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:4800 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3666
Practice Address - Country:US
Practice Address - Phone:334-756-1848
Practice Address - Fax:334-756-1854
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-078798367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00692162OtherRAILROAD PROVIDER #
GA735502860AMedicaid
GA1700069887OtherBC BS OF GEORGIA
AL100166Medicaid
AL515-45747OtherBC BS OF AL
AL100166Medicaid