MEDICARE: SALLY MAE BAIRD NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5003987	NC

General Provider Information

NPI Number	:	1710153515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY MAE BAIRD NP-C

Provider Business Mailing Address
First Line	:	321 MULBERRY ST SW
Second Line	:	MEDICAL STAFF SERVICES
City	:	LENOIR
State	:	NC
Zip	:	28645-5720
Country	:	US
Telephone Number	:	828-757-5965
Fax Number	:	828-757-5104

Provider Business Practice Location Address
First Line	:	270 PINE MOUNTAIN RD
Second Line	:	SUITE 2
City	:	HUDSON
State	:	NC
Zip	:	28638-2605
Country	:	US
Telephone Number	:	828-757-6330
Fax Number	:	828-757-6349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	03/17/2021

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