Healthcare Provider Details

I. General information

NPI: 1306351192
Provider Name (Legal Business Name): JENNIFER A BIRDSONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2017
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 GOBLIN DR
HARRISON AR
72601-8885
US

IV. Provider business mailing address

2121 MARION COUNTY 4026
EVERTON AR
72633-9646
US

V. Phone/Fax

Practice location:
  • Phone: 870-654-3869
  • Fax:
Mailing address:
  • Phone: 816-261-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: