Healthcare Provider Details

I. General information

NPI: 1457071698
Provider Name (Legal Business Name): KENNA JADE FIELDS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 N MAYO TRL
PIKEVILLE KY
41501-3210
US

IV. Provider business mailing address

1382 SUNSET HOLLOW RD
GRUNDY VA
24614-6723
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-0331
  • Fax:
Mailing address:
  • Phone: 276-275-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023040
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: