Healthcare Provider Details

I. General information

NPI: 1770073843
Provider Name (Legal Business Name): KARA FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 KENT DR
SOUTHAVEN MS
38672-7237
US

IV. Provider business mailing address

5960 GETWELL RD STE 212D
SOUTHAVEN MS
38672-7320
US

V. Phone/Fax

Practice location:
  • Phone: 662-228-0130
  • Fax:
Mailing address:
  • Phone: 662-228-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number261026
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: