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 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-351-1500
Practice Address - Fax:304-351-1510
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV105549363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner