Provider Demographics
NPI:1750124699
Name:KINGBIRD, ANDREW S (CHW, CASE MANAGER)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:KINGBIRD
Suffix:
Gender:M
Credentials:CHW, CASE MANAGER
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 280
Mailing Address - Street 2:
Mailing Address - City:RED LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0280
Mailing Address - Country:US
Mailing Address - Phone:218-679-3171
Mailing Address - Fax:218-679-3451
Practice Address - Street 1:PO BOX 280
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0280
Practice Address - Country:US
Practice Address - Phone:218-679-3171
Practice Address - Fax:218-679-3451
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker