Provider Demographics
NPI:1043549371
Name:BIRDWELL, MISTY L (APN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:L
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N MOOSE ST
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-2912
Mailing Address - Country:US
Mailing Address - Phone:501-287-5323
Mailing Address - Fax:888-830-6538
Practice Address - Street 1:110 N BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9475
Practice Address - Country:US
Practice Address - Phone:501-679-3551
Practice Address - Fax:501-679-4536
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2024-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARAOO1712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily