Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | TEMPORARY | MO |
NPI | 1619547726 |
---|---|
Provider Name | Dr. Heather Rachelle Bird |
First Address | Kirksville, MO 63501-3022 |
Second Address | Kirksville, MO 63501-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2021 |
Last Update Date | 30/06/2021 |