Provider Demographics
NPI:1548717614
Name:BIRCHFIELD, KEITH NOBLE
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:NOBLE
Last Name:BIRCHFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 UNION ROAD 434
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762-9000
Mailing Address - Country:US
Mailing Address - Phone:870-725-4416
Mailing Address - Fax:
Practice Address - Street 1:387 UNION ROAD 434
Practice Address - Street 2:
Practice Address - City:SMACKOVER
Practice Address - State:AR
Practice Address - Zip Code:71762-9409
Practice Address - Country:US
Practice Address - Phone:870-725-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer