Healthcare Provider Details

I. General information

NPI: 1669259032
Provider Name (Legal Business Name): CHRISTINE FIELDS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71211 LA-21
COVINGTON LA
70433
US

IV. Provider business mailing address

1381 AUDUBON PKWY
MADISONVILLE LA
70447-3271
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-9922
  • Fax:
Mailing address:
  • Phone: 985-778-3010
  • Fax: 985-778-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232138
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: