Provider Demographics
NPI:1447697453
Name:FIELDS, KRISTEN P (PT, MPT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:P
Last Name:FIELDS
Suffix:
Gender:F
Credentials:PT, MPT, DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:P
Other - Last Name:CLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 S BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1306
Mailing Address - Country:US
Mailing Address - Phone:620-218-5193
Mailing Address - Fax:
Practice Address - Street 1:716 N 119TH ST W
Practice Address - Street 2:SUITE 112
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1938
Practice Address - Country:US
Practice Address - Phone:316-721-1900
Practice Address - Fax:316-721-1926
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist