Provider Demographics
NPI:1083151799
Name:BIRD, SARAH P (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:P
Last Name:BIRD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4658 MONUMENT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-2555
Mailing Address - Country:US
Mailing Address - Phone:860-803-7671
Mailing Address - Fax:
Practice Address - Street 1:13950 BALLANTYNE CORPORATE PL STE 155
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3163
Practice Address - Country:US
Practice Address - Phone:704-523-5745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011783363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health