Healthcare Provider Details

I. General information

NPI: 1295058873
Provider Name (Legal Business Name): MS. KIMBERLY A FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 N 8TH ST
PHILADELPHIA PA
19120-3108
US

IV. Provider business mailing address

5162 N 8TH ST
PHILADELPHIA PA
19120-3108
US

V. Phone/Fax

Practice location:
  • Phone: 215-329-4039
  • Fax: 215-329-4059
Mailing address:
  • Phone: 215-329-4039
  • Fax: 215-329-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: