Individual
KELLY FIELDS-WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
610 N ONE MILE RD, DEXTER, MO 63841-2539
(573) 624-3600
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2001026712
MO
Other
Enumeration date
01/04/2011
Last updated
09/01/2020
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