Healthcare Provider Details

I. General information

NPI: 1679410963
Provider Name (Legal Business Name): LAUREN ELYSE MCBRIDE DNP PMHNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ELYSE MCBRIDE DNP PMHNP BC

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SOUTHPOINTE DR STE A
EDWARDSVILLE IL
62025-3780
US

IV. Provider business mailing address

103 SOUTHPOINTE DR STE A
EDWARDSVILLE IL
62025-3780
US

V. Phone/Fax

Practice location:
  • Phone: 616-656-2000
  • Fax:
Mailing address:
  • Phone: 618-656-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041571586
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209036045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: