Healthcare Provider Details

I. General information

NPI: 1508814518
Provider Name (Legal Business Name): KIMBERLY A. BIRD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY A. WITHROW RN

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE HOSPITALISTS PROGRAM
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

3200 MACCORKLE AVENUE SE OUTPATIENT CARE CLINIC
CHARLESTON WV
25304
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5848
  • Fax: 304-388-9654
Mailing address:
  • Phone: 304-388-5590
  • Fax: 304-388-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number49155
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number49155
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: