Provider Demographics
NPI:1275226631
Name:FORD MCBRIDE, CHRISTE TASHAY (LPN, BSHA)
Entity Type:Individual
Prefix:
First Name:CHRISTE
Middle Name:TASHAY
Last Name:FORD MCBRIDE
Suffix:
Gender:F
Credentials:LPN, BSHA
Other - Prefix:
Other - First Name:CHRISTE
Other - Middle Name:TASHAY
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN, BSHA
Mailing Address - Street 1:424 SHADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4155
Mailing Address - Country:US
Mailing Address - Phone:662-263-6044
Mailing Address - Fax:
Practice Address - Street 1:424 SHADOWOOD DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4155
Practice Address - Country:US
Practice Address - Phone:662-263-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP316202171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator