Basic Information
| Provider Information | |||||||||
| NPI: | 1164077137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCBRIDE | ||||||||
| FirstName: | BAYLEE | ||||||||
| MiddleName: | CHEYENNE | ||||||||
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| Credential: | RN, BSN IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23954 E 1340 RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730622037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809193248 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3401 W GORE BLVD | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803558620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2019 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | L-155471 | OK | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
ID Information
| ID | Type | State | Issuer | Description | 122010 | 05 | OK | MEDICAID |