Provider Demographics
NPI:1437402476
Name:BIRD, KIMBERLY ELIZABETH (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:BIRD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELIZABETH
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3542
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309-3542
Mailing Address - Country:US
Mailing Address - Phone:330-996-0347
Mailing Address - Fax:330-996-0359
Practice Address - Street 1:75 ARCH ST STE B1
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1474
Practice Address - Country:US
Practice Address - Phone:330-375-4844
Practice Address - Fax:330-375-4067
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13859-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health