MEDICARE: MRS. SALLY ANN BIRD FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	593057	TX

General Provider Information

NPI Number	:	1073539631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY ANN BIRD FNP-C

Provider Business Mailing Address
First Line	:	2222 W 24TH ST
Second Line	:
City	:	PLAINVIEW
State	:	TX
Zip	:	79072-1802
Country	:	US
Telephone Number	:	806-293-5113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 W 24TH ST
Second Line	:
City	:	PLAINVIEW
State	:	TX
Zip	:	79072-1802
Country	:	US
Telephone Number	:	806-293-5113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/08/2007

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