Provider Demographics
NPI:1962420687
Name:FIELDER, FAYE A (ANP)
Entity type:Individual
Prefix:MS
First Name:FAYE
Middle Name:A
Last Name:FIELDER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4921 PARKVIEW PL STE 13A
Mailing Address - Street 2:STE 13A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-333-4100
Mailing Address - Fax:314-333-4115
Practice Address - Street 1:4921 PARKVIEW PL STE 13A
Practice Address - Street 2:STE 13A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-333-4100
Practice Address - Fax:314-333-4115
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO058173363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429229115Medicaid
MO821520232Medicaid
MO821520232Medicare PIN