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General NPI Number Information
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NPI Number | 1659167724
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Entity Type | Individual
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Provider Name | JUSTIN KERRY FIELDS
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Gender | Male
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1824 VINE AVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-3362
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Country | US
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Telephone | 530-405-7237
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Fax |
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Provider Business Mailing Address
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Address Line | 6914 REDSTART RD
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-9244
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Country | US
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Telephone | 530-405-7237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 112924
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License Number State | OR
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