MEDICARE: CHOLOTTIE JANE FIELDS ISSA- CPT

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	174400000X	Specialist	991169	AZ

General Provider Information

NPI Number	:	1659041572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHOLOTTIE JANE FIELDS ISSA- CPT

Provider Business Mailing Address
First Line	:	952 WINCHESTER RD STE 5
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-3948
Country	:	US
Telephone Number	:	859-270-7468
Fax Number	:

Provider Business Practice Location Address
First Line	:	952 WINCHESTER RD STE 5
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-3948
Country	:	US
Telephone Number	:	859-270-7468
Fax Number	:

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

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	05/29/2026

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