Provider Demographics
NPI:1073369377
Name:MCBRIDE, JENNIFER LEA
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
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 1:221 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2609
Mailing Address - Country:US
Mailing Address - Phone:681-238-6634
Mailing Address - Fax:681-238-6638
Practice Address - Street 1:221 GEORGE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2609
Practice Address - Country:US
Practice Address - Phone:681-238-6634
Practice Address - Fax:681-238-6638
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist