Provider Demographics
NPI:1639822240
Name:BIRD, KAITLIN MIKEL (APRN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MIKEL
Last Name:BIRD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:WY
Mailing Address - Zip Code:82939-0414
Mailing Address - Country:US
Mailing Address - Phone:307-884-3644
Mailing Address - Fax:
Practice Address - Street 1:586 MOOSE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:ROBERTSON
Practice Address - State:WY
Practice Address - Zip Code:82944-5070
Practice Address - Country:US
Practice Address - Phone:307-884-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily