Healthcare Provider Details

I. General information

NPI: 1679295133
Provider Name (Legal Business Name): KRISTA LEIGH MCBRIDE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E CHURCH ST
SANTA MARIA CA
93454-5906
US

IV. Provider business mailing address

1451 BRANCH MILL RD
ARROYO GRANDE CA
93420-5209
US

V. Phone/Fax

Practice location:
  • Phone: 805-332-8390
  • Fax:
Mailing address:
  • Phone: 805-440-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number95064500
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95064500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: