Provider Demographics
NPI:1336024439
Name:FIELDS, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 RUNYON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PINSONFORK
Mailing Address - State:KY
Mailing Address - Zip Code:41555-7403
Mailing Address - Country:US
Mailing Address - Phone:304-784-2395
Mailing Address - Fax:
Practice Address - Street 1:368 RUNYON BRANCH RD
Practice Address - Street 2:
Practice Address - City:PINSONFORK
Practice Address - State:KY
Practice Address - Zip Code:41555-7403
Practice Address - Country:US
Practice Address - Phone:304-784-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant