Provider Demographics
NPI:1982456893
Name:BLUEBIRD HEALTH PLLC
Entity Type:Organization
Organization Name:BLUEBIRD HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-935-3076
Mailing Address - Street 1:112 W CENTER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6073
Mailing Address - Country:US
Mailing Address - Phone:479-935-3076
Mailing Address - Fax:833-259-4137
Practice Address - Street 1:112 W CENTER ST STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6073
Practice Address - Country:US
Practice Address - Phone:479-935-3076
Practice Address - Fax:833-259-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty