Healthcare Provider Details

I. General information

NPI: 1568902922
Provider Name (Legal Business Name): JAMIE BIRD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE E LEDFORD NP-C

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date: 03/23/2021
Reactivation Date: 05/25/2021

III. Provider practice location address

2620 WESTSIDE DR NW
CLEVELAND TN
37312-3605
US

IV. Provider business mailing address

2620 WESTSIDE DR NW
CLEVELAND TN
37312-3605
US

V. Phone/Fax

Practice location:
  • Phone: 423-339-1760
  • Fax: 423-559-1483
Mailing address:
  • Phone: 423-339-1760
  • Fax: 423-559-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number22496
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: