Healthcare Provider Details

I. General information

NPI: 1780993014
Provider Name (Legal Business Name): MRS. KELLY MCBRIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S ROBINSON ST
TEHACHAPI CA
93561-1723
US

IV. Provider business mailing address

840 TUCKER RD STE H362
TEHACHAPI CA
93561-2564
US

V. Phone/Fax

Practice location:
  • Phone: 661-903-8822
  • Fax:
Mailing address:
  • Phone: 661-762-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW88414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: