Healthcare Provider Details

I. General information

NPI: 1114663911
Provider Name (Legal Business Name): BAILEE DEE BIRD PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12330 W 3000 N
BLUEBELL UT
84007-9701
US

IV. Provider business mailing address

HC 65 BOX 20
BLUEBELL UT
84007-9701
US

V. Phone/Fax

Practice location:
  • Phone: 435-253-0384
  • Fax:
Mailing address:
  • Phone: 435-253-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number141882848906
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: