Healthcare Provider Details

I. General information

NPI: 1306828181
Provider Name (Legal Business Name): KELLY A FIELDS A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 A ST STE 201
LINCOLN NE
68510-4283
US

IV. Provider business mailing address

7111 A ST STE 201
LINCOLN NE
68510-4283
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-7100
  • Fax:
Mailing address:
  • Phone: 402-489-7100
  • Fax: 402-489-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number110241
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: