Healthcare Provider Details

I. General information

NPI: 1497387799
Provider Name (Legal Business Name): LORI ANNE BIRD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAMONT STREET & VETERANS WAY
JOHNSON CITY TN
37604
US

IV. Provider business mailing address

131 NOLICHUCKEY OVERLOOK
GREENEVILLE TN
37743-6329
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax: 423-979-3043
Mailing address:
  • Phone: 423-926-1171
  • Fax: 423-979-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26212
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: