Provider Demographics
NPI:1881283018
Name:FIELDS, STACY SUSAN
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:SUSAN
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:SUSAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1529 MCCORMICK RD LOT 8
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8688
Mailing Address - Country:US
Mailing Address - Phone:740-645-8851
Mailing Address - Fax:
Practice Address - Street 1:1460 NEIGHBORHOOD RD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8010
Practice Address - Country:US
Practice Address - Phone:740-446-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00094594Medicaid