Provider Demographics
NPI:1275956583
Name:MCBRIDE, FELECIA
Entity Type:Individual
Prefix:
First Name:FELECIA
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLEVELAND AVE
Mailing Address - Street 2:SUITE # 14
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2937
Mailing Address - Country:US
Mailing Address - Phone:276-632-9714
Mailing Address - Fax:
Practice Address - Street 1:324 T B STANLEY HWY STE B&C
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:VA
Practice Address - Zip Code:24055-6108
Practice Address - Country:US
Practice Address - Phone:276-629-1076
Practice Address - Fax:276-629-2695
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily