Healthcare Provider Details

I. General information

NPI: 1497239487
Provider Name (Legal Business Name): LADINA R FIELDS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 E 2ND AVE STE 210
WILLIAMSON WV
25661-3602
US

IV. Provider business mailing address

300 PROSPERITY LN STE 204
LOGAN WV
25601-3743
US

V. Phone/Fax

Practice location:
  • Phone: 304-236-5902
  • Fax: 855-487-4047
Mailing address:
  • Phone: 304-792-7130
  • Fax: 304-896-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN63067-FNP-BC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: