Healthcare Provider Details

I. General information

NPI: 1659041572
Provider Name (Legal Business Name): CHOLOTTIE JANE FIELDS ISSA- CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 WINCHESTER RD STE 5
LEXINGTON KY
40505-3948
US

IV. Provider business mailing address

952 WINCHESTER RD STE 5
LEXINGTON KY
40505-3948
US

V. Phone/Fax

Practice location:
  • Phone: 859-270-7468
  • Fax:
Mailing address:
  • Phone: 859-270-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number991169
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: