1629063763 NPI number — LORI A FIELDS APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629063763 NPI number — LORI A FIELDS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIELDS
Provider First Name:
LORI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAWYER OR FIELDS ABD HUFFMAN
Provider Other First Name:
LORI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629063763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6908 COLTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40014-8468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-296-0768
Provider Business Mailing Address Fax Number:
502-429-6157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 W RUSSELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHORN CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41522-9032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-226-8874
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3002571 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 3002571 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100264630 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71012039A . This is a "IN APRN-COMPACT RN LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 3002571 . This is a "KY APRN LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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