Healthcare Provider Details

I. General information

NPI: 1134102635
Provider Name (Legal Business Name): JEANNE LOUISE FIELDER PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOWARD ST
KALAMAZOO MI
49001-2748
US

IV. Provider business mailing address

401 HOWARD ST
KALAMAZOO MI
49001-2748
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4458
  • Fax: 269-344-4459
Mailing address:
  • Phone: 269-344-4458
  • Fax: 269-344-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001350
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: