Basic Information
| Provider Information | |||||||||
| NPI: | 1558382333 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1459 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068923208 | ||||||||
| FaxNumber: | 4068924535 | ||||||||
| Practice Location | |||||||||
| Address1: | 2165 9TH ST WEST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068923208 | ||||||||
| FaxNumber: | 4068924535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 09/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R11441 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 437489 | 05 | MT | MEDICAID |