Provider Demographics
NPI:1447513734
Name:BIRD, HEIDI JOY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JOY
Last Name:BIRD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:JOY
Other - Last Name:EASTEP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 S BANEY RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4574
Mailing Address - Country:US
Mailing Address - Phone:419-289-1133
Mailing Address - Fax:419-289-1132
Practice Address - Street 1:2021 S BANEY RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4574
Practice Address - Country:US
Practice Address - Phone:419-289-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATMA052640363A00000X, 363AM0700X
OH50.003875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATMA052640OtherTEMPORARY PHYSICIAN ASST PRACTICE PERMIT