Healthcare Provider Details

I. General information

NPI: 1003429127
Provider Name (Legal Business Name): MYKALLA HOPE FIELDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 SPENCER ST STE 118
LAS VEGAS NV
89119-5250
US

IV. Provider business mailing address

2675 S NELLIS BLVD APT 2165
LAS VEGAS NV
89121-2077
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-9710
  • Fax:
Mailing address:
  • Phone: 323-821-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: