Provider Demographics
NPI:1851659270
Name:BIRD, KRISTEN SMITH (FNP-BC, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:SMITH
Last Name:BIRD
Suffix:
Gender:F
Credentials:FNP-BC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BLAIR PARK RD STE 285
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7586
Mailing Address - Country:US
Mailing Address - Phone:802-288-1140
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:1127 NORTH AVE
Practice Address - Street 2:SUITE 41
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-2757
Practice Address - Country:US
Practice Address - Phone:802-846-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT10912104163WL0100X
VT101.0085890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020570Medicaid
VT1020570Medicaid