Healthcare Provider Details

I. General information

NPI: 1104782184
Provider Name (Legal Business Name): HEATHER MICHELLE BIRD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CHESAPEAKE PLZ
CHESAPEAKE OH
45619-1003
US

IV. Provider business mailing address

9 CHESAPEAKE PLZ
CHESAPEAKE OH
45619-1003
US

V. Phone/Fax

Practice location:
  • Phone: 740-340-1602
  • Fax:
Mailing address:
  • Phone: 740-340-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0043264
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: