Provider Demographics
NPI:1699722967
Name:FIELDS, LINDA S (PA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:FIELDS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-6003
Practice Address - Fax:573-884-5410
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003009746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111238/177928OtherBLUE SHIELD/BLUE CHOICE
MO550179OtherHEALTHLINK
MOP00072935Medicare PIN
ME111238/177928OtherBLUE SHIELD/BLUE CHOICE
P27664Medicare UPIN