Provider Demographics
NPI:1306351192
Name:BIRDSONG, JENNIFER A
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 MARION COUNTY 4026
Mailing Address - Street 2:
Mailing Address - City:EVERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72633-9646
Mailing Address - Country:US
Mailing Address - Phone:816-261-4227
Mailing Address - Fax:
Practice Address - Street 1:916 GOBLIN DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-8885
Practice Address - Country:US
Practice Address - Phone:870-654-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist