Healthcare Provider Details

I. General information

NPI: 1952502049
Provider Name (Legal Business Name): CHARLES ALLAN MCBRIDE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 LOUISIANA ST SUITE 17006C
HOUSTON TX
77002-4916
US

IV. Provider business mailing address

2925 HARGRAVE RD
HUFFMAN TX
77336-3457
US

V. Phone/Fax

Practice location:
  • Phone: 713-241-1183
  • Fax:
Mailing address:
  • Phone: 281-360-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP112032
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAP112032
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: