Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | AT1375 | KY |
N | 2081S0010X | Sports Medicine | AT1375 | KY |
N | 213ES0000X | Sports Medicine | AT1375 | KY |
NPI | 1851742027 |
---|---|
Provider Name | Melissa Suzanne Fields |
First Address | Edgewood, KY 41017-3403 |
Second Address | Edgewood, KY 41017-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2016 |
Last Update Date | 25/01/2020 |