Provider Demographics
NPI:1164077137
Name:MCBRIDE, BAYLEE CHEYENNE (RN, BSN IBCLC)
Entity Type:Individual
Prefix:
First Name:BAYLEE
Middle Name:CHEYENNE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:RN, BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23954 E 1340 RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73062-2037
Mailing Address - Country:US
Mailing Address - Phone:580-919-3248
Mailing Address - Fax:
Practice Address - Street 1:3401 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6332
Practice Address - Country:US
Practice Address - Phone:580-355-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-155471163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK122010Medicaid