Provider Demographics
NPI:1790388288
Name:MCBRYDE, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MCBRYDE
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 1:112 WEATHERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8743
Mailing Address - Country:US
Mailing Address - Phone:304-412-3214
Mailing Address - Fax:
Practice Address - Street 1:112 WEATHERIDGE DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8743
Practice Address - Country:US
Practice Address - Phone:304-412-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV105549363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner