MEDICARE: KIMMESHRANDA FIELDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		TX

General Provider Information

NPI Number	:	1639832421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMMESHRANDA FIELDS

Provider Business Mailing Address
First Line	:	3648 CYPRESS CREEK PKWY STE 121B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3609
Country	:	US
Telephone Number	:	314-755-9653
Fax Number	:

Provider Business Practice Location Address
First Line	:	3648 CYPRESS CREEK PKWY STE 121B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3609
Country	:	US
Telephone Number	:	314-755-9653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	10/19/2021

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Directions to “ KIMMESHRANDA FIELDS ” Practice Location

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