Individual
MS. KEISHA R. BIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 390-3759
(904) 390-3429
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-6212
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP 9195075
FL
363LP0200X
Pediatric Nurse Practitioner
ARNP 9195075
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104862505A
—
GA
05
—
305157900
—
FL
Enumeration date
09/27/2006
Last updated
11/21/2016
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