Individual
MRS. CHARLA FIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHW-C, CPHT
Contact information
Practice address
1173 E HINES ST, REPUBLIC, MO 65738-1277
(417) 735-0055
Mailing address
1173 E HINES ST, REPUBLIC, MO 65738-1277
(417) 735-0055
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
13248
MO
183700000X
Pharmacy Technician
2011006391
MO
Other
Enumeration date
09/15/2021
Last updated
09/15/2021
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