Basic Information
Provider Information
NPI: 1578016895
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCBRIDE
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 15849
Address2:  
City: SAVANNAH
State: GA
PostalCode: 314162549
CountryCode: US
TelephoneNumber: 9123033560
FaxNumber: 9123033506
Practice Location
Address1: 1326 EISENHOWER DR
Address2: BLDG 2
City: SAVANNAH
State: GA
PostalCode: 314063928
CountryCode: US
TelephoneNumber: 9123033560
FaxNumber: 9123033506
Other Information
ProviderEnumerationDate: 08/03/2016
LastUpdateDate: 11/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN213131GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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