Provider Demographics
NPI:1447298393
Name:FIELDS, KATHLEEN A (CNM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1972
Mailing Address - Country:US
Mailing Address - Phone:908-454-4666
Mailing Address - Fax:908-454-2332
Practice Address - Street 1:700 COVENTRY DR
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1972
Practice Address - Country:US
Practice Address - Phone:908-454-4666
Practice Address - Fax:908-454-2332
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00014201367A00000X
PAMW008437L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6223508Medicaid
NJ420001626OtherRAILROAD MEDICARE
NJ420001626OtherRAILROAD MEDICARE
NJ041983CJEMedicare PIN
NJ041983Medicare PIN