Provider Demographics
NPI:1700212354
Name:BIRD, SHELLEY ANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANN
Last Name:BIRD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 E EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3905
Mailing Address - Country:US
Mailing Address - Phone:417-766-3479
Mailing Address - Fax:
Practice Address - Street 1:2021 E INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3748
Practice Address - Country:US
Practice Address - Phone:417-885-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013032148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily