Provider Demographics
NPI:1215333075
Name:FIELDS, LISA LAVON (APRN, PMHNP-BC, CPNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LAVON
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC, CPNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LAVON
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CPNP
Mailing Address - Street 1:PO BOX 2292
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-2292
Mailing Address - Country:US
Mailing Address - Phone:479-684-6776
Mailing Address - Fax:
Practice Address - Street 1:5434 W WALSH LN
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8946
Practice Address - Country:US
Practice Address - Phone:479-443-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126713363LP0200X
ARA004072363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200697640Medicaid
MO1215333075Medicaid
AR210116758Medicaid
AR210116758Medicaid