Provider Demographics
NPI:1245817733
Name:BLUEBIRD, SKYLAR MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:MICHELLE
Last Name:BLUEBIRD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 MAPLE AVE APT 374
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6584
Mailing Address - Country:US
Mailing Address - Phone:210-296-9235
Mailing Address - Fax:
Practice Address - Street 1:4333 N JOSEY LN STE 302
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4632
Practice Address - Country:US
Practice Address - Phone:469-535-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14484363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical