Healthcare Provider Details

I. General information

NPI: 1629664115
Provider Name (Legal Business Name): JACQUELINE MCBRIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE FLOYD

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 5TH ST
HENDERSON KY
42420-3052
US

IV. Provider business mailing address

438 5TH ST
HENDERSON KY
42420-3052
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-4652
  • Fax: 615-815-1946
Mailing address:
  • Phone: 270-832-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65846
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65846
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number286318
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-30043
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: