Provider Demographics
NPI:1982213765
Name:MCBRIDE, MICHAELA LYNNE
Entity Type:Individual
Prefix:MISS
First Name:MICHAELA
Middle Name:LYNNE
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 1:9541 KINGS PARADE BLVD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5819
Mailing Address - Country:US
Mailing Address - Phone:845-649-2336
Mailing Address - Fax:
Practice Address - Street 1:9541 KINGS PARADE BLVD UNIT 107
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5819
Practice Address - Country:US
Practice Address - Phone:845-649-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical