Provider Demographics
NPI:1700978848
Name:FIELDS, WENDY (ANP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 SUSANNAH ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1728
Mailing Address - Country:US
Mailing Address - Phone:423-282-5054
Mailing Address - Fax:
Practice Address - Street 1:2408 SUSANNAH ST
Practice Address - Street 2:STE. 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1728
Practice Address - Country:US
Practice Address - Phone:423-282-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN06844363LA2200X
VA0024174224363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3929153Medicaid
TN0107OtherJDH
TN4088547OtherBCBS
TN3373123Medicaid
VTVVM996AMedicare PIN
Q19625Medicare UPIN
GAP00101576Medicare ID - Type UnspecifiedRAILROAD
TN3373123Medicare ID - Type UnspecifiedGROUP
TN3373123Medicaid