Provider Demographics
NPI:1093066557
Name:MCBRIDE, BRITTLYN SHEA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITTLYN
Middle Name:SHEA
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BRITTLYN
Other - Middle Name:S
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2350 EAST G AVE
Mailing Address - Street 2:
Mailing Address - City:PARCHMENT
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1943
Mailing Address - Country:US
Mailing Address - Phone:269-344-6183
Mailing Address - Fax:269-349-3046
Practice Address - Street 1:2350 EAST G AVE
Practice Address - Street 2:
Practice Address - City:PARCHMENT
Practice Address - State:MI
Practice Address - Zip Code:49004-1943
Practice Address - Country:US
Practice Address - Phone:269-344-6183
Practice Address - Fax:269-349-3046
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006471363AM0700X, 363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04740012Medicare PIN