Healthcare Provider Details

I. General information

NPI: 1336855097
Provider Name (Legal Business Name): RACINE FIELDS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACINE J FIELDS-GREEN RN, BSN

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 NORTH ST
BATON ROUGE LA
70802-3154
US

IV. Provider business mailing address

2285 NORTH ST
BATON ROUGE LA
70802-3154
US

V. Phone/Fax

Practice location:
  • Phone: 225-218-5647
  • Fax: 225-259-3821
Mailing address:
  • Phone: 225-218-5647
  • Fax: 225-259-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9533277
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN115553
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN115553
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberRN115553
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: