Healthcare Provider Details

I. General information

NPI: 1982456893
Provider Name (Legal Business Name): BLUEBIRD HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W CENTER ST STE 200
FAYETTEVILLE AR
72701-6073
US

IV. Provider business mailing address

112 W CENTER ST STE 200
FAYETTEVILLE AR
72701-6073
US

V. Phone/Fax

Practice location:
  • Phone: 479-935-3076
  • Fax: 833-259-4137
Mailing address:
  • Phone: 479-935-3076
  • Fax: 833-259-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH MARTIN BERNER
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 479-935-3076