Provider Demographics
NPI:1508814518
Name:BIRD, KIMBERLY A (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:BIRD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:WITHROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3200 MACCORKLE AVENUE SE
Mailing Address - Street 2:OUTPATIENT CARE CLINIC
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-5590
Mailing Address - Fax:304-388-8238
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:HOSPITALISTS PROGRAM
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-5848
Practice Address - Fax:304-388-9654
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49155363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7101155000Medicaid
WV2031105Medicare PIN
WV2031104Medicare PIN
BI2031106Medicare PIN
P00723842Medicare PIN
WVBINP77081Medicare ID - Type Unspecified
WV2031101Medicare PIN
BINP77081Medicare PIN
WV7101155000Medicaid
WV2031102Medicare PIN
WV2031103Medicare PIN