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General NPI Number Information
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NPI Number | 1215386222
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Entity Type | Individual
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Provider Name | CRYSTAL MAE-MICHELLE BAIRD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 1755 N MECKLENBURG AVE
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City | SOUTH HILL
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State | VA
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Zip | 23970-4080
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Country | US
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Telephone | 434-584-5462
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Fax |
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Provider Business Mailing Address
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Address Line | 702 N. MAIN ST.
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City | EMPORIA
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State | VA
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Zip | 23847
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Country | US
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Telephone | 434-634-7723
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Fax | 434-634-7725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024173589
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License Number State | VA
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