Provider Demographics
NPI:1568902922
Name:BIRD, JAMIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:E
Other - Last Name:LEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:6784 US 411
Mailing Address - Street 2:P.O. BOX
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307
Mailing Address - Country:US
Mailing Address - Phone:423-338-8995
Mailing Address - Fax:423-338-8996
Practice Address - Street 1:305 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322
Practice Address - Country:US
Practice Address - Phone:423-338-8995
Practice Address - Fax:423-338-8996
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2021-05-25
Deactivation Date:2021-03-23
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
TN22496363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care