Provider Demographics
NPI:1215768429
Name:FIELDS, EBONY DAWN-COMPTON
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:DAWN-COMPTON
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SE AVE K
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-5008
Mailing Address - Country:US
Mailing Address - Phone:580-212-2787
Mailing Address - Fax:
Practice Address - Street 1:312 SE AVE K
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-5008
Practice Address - Country:US
Practice Address - Phone:580-212-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKG081497136171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator