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: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date: 03/23/2021
Reactivation Date: 05/25/2021

III. Provider practice location address

305 RIVER ROAD
DECATUR TN
37322
US

IV. Provider business mailing address

6784 US 411 P.O. BOX
BENTON TN
37307
US

V. Phone/Fax

Practice location:
  • Phone: 423-338-8995
  • Fax: 423-338-8996
Mailing address:
  • Phone: 423-338-8995
  • Fax: 423-338-8996

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: