Provider Demographics
NPI:1275635377
Name:MCBRIDE, TAMI LEE (CNM)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:LEE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5047
Mailing Address - Country:US
Mailing Address - Phone:918-342-6252
Mailing Address - Fax:918-342-6408
Practice Address - Street 1:101 S MOORE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5047
Practice Address - Country:US
Practice Address - Phone:918-342-6252
Practice Address - Fax:918-342-6408
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN134561 & AP2278367A00000X
OK70669367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0149610OtherBCBS
OK200247120AMedicaid
AZ976417Medicaid
AZ976417Medicaid
AZ030078Medicare Oscar/Certification
OK8HI525Medicare PIN
OK200247120AMedicaid