Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1073975538 |
---|---|
Provider Name | Kameesha Mcbride |
First Address | Pflugerville, TX 78691-0442 |
Second Address | Round Rock, TX 78681-6934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2016 |
Last Update Date | 17/03/2018 |