Provider Demographics
NPI:1760115901
Name:MCCORMICK, WINTRESS BLYTH (LPN, CBC)
Entity Type:Individual
Prefix:MS
First Name:WINTRESS
Middle Name:BLYTH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LPN, CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 HIGHWAY 190 STE C
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4962
Mailing Address - Country:US
Mailing Address - Phone:985-871-7337
Mailing Address - Fax:985-871-7600
Practice Address - Street 1:7020 HIGHWAY 190 STE C
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4962
Practice Address - Country:US
Practice Address - Phone:985-871-7337
Practice Address - Fax:985-871-7600
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20180342164W00000X
LA22098174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA22098OtherPREPARED CHILDBIRTH EDUCATORS
LA20180342OtherLOUISIANA STATE BOARD OF NURSING