=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215443486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIELDS FAMILY PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2017
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5720 FAYETTEVILLE RD STE 203
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-5333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-551-5800
-----------------------------------------------------
Fax | 919-336-4725
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5720 FAYETTEVILLE RD STE 203
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-5333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-551-5800
-----------------------------------------------------
Fax | 919-336-4725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER/NURSE PRACTITIONER
-----------------------------------------------------
Name | WENDY SMITH FIELDS
-----------------------------------------------------
Credential | PMHNP-BC, FNP-C
-----------------------------------------------------
Telephone | 919-551-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------