Provider Demographics
NPI:1427282110
Name:MCBRIDE, CASEY MARTIN
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:MARTIN
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHERRILL
Other - Middle Name:LEE
Other - Last Name:MESSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:318 ORIENT ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5442
Mailing Address - Country:US
Mailing Address - Phone:530-514-9208
Mailing Address - Fax:
Practice Address - Street 1:318 ORIENT ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5442
Practice Address - Country:US
Practice Address - Phone:530-514-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN167156164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse