Provider Demographics
NPI:1598082679
Name:BIRD, AMY MICHELLE (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:BIRD
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:VANZANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 OMEGA DR STE 208
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2075
Mailing Address - Country:US
Mailing Address - Phone:817-465-5881
Mailing Address - Fax:817-465-6336
Practice Address - Street 1:1201 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4215
Practice Address - Country:US
Practice Address - Phone:817-335-5288
Practice Address - Fax:817-338-0927
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX708068363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX708068OtherLICENSE