Provider Demographics
NPI:1316549082
Name:MCBRIDE, KEISA YVETTE (MPH)
Entity Type:Individual
Prefix:
First Name:KEISA
Middle Name:YVETTE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10611 NW STATE ROAD 20
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-3441
Mailing Address - Country:US
Mailing Address - Phone:850-643-1033
Mailing Address - Fax:850-643-5066
Practice Address - Street 1:10611 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3441
Practice Address - Country:US
Practice Address - Phone:850-643-1033
Practice Address - Fax:850-643-5066
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty