Provider Demographics
NPI:1073506572
Name:BIRD, KIMBERLY COATES (MD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:COATES
Last Name:BIRD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:159 EXECUTIVE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4160
Mailing Address - Country:US
Mailing Address - Phone:434-792-4378
Mailing Address - Fax:434-799-0860
Practice Address - Street 1:159 EXECUTIVE DR
Practice Address - Street 2:SUITE F
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-792-4378
Practice Address - Fax:434-799-0860
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238775207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010200326Medicaid
VA010200326Medicaid
G93368Medicare UPIN