MEDICARE: JULIE NICOLE MCBRIDE PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	25980	TN

General Provider Information

NPI Number	:	1598324006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE NICOLE MCBRIDE PMHNP-BC

Provider Business Mailing Address
First Line	:	820 OLD PARKSVILLE RD NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-5010
Country	:	US
Telephone Number	:	423-310-7950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 MOUNT VERNON DR NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3539
Country	:	US
Telephone Number	:	423-473-2633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2019
Last Update Date	:	06/08/2019

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