Provider Demographics
NPI:1841977758
Name:FIELDS, ALISA NICHOLE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:NICHOLE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4264 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5686
Mailing Address - Country:US
Mailing Address - Phone:402-484-1516
Mailing Address - Fax:
Practice Address - Street 1:4264 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-5686
Practice Address - Country:US
Practice Address - Phone:402-484-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82348133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management