| Doctor Name: | TENNILLE MCBRIDE |
| NPI Number: | 1114384138 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | APN.0992173 |
| Business Practice Address: | 201 Kendall Dr Lamar, CO - 810523939 |
| Business Phone Number: | 7193360261 |
| Business Fax Number: | 7193360265 |
| Mailing Address: | 201 Kendall Dr, LAMAR |
| State: | CO |
| Postal Code: | 810523939 |
| Phone Number: | 7193360261 |
| Fax Number: | 7193360265 |
| NPI Enumeration Date: | 01/21/2016 |
| NPI Last Update Date: | 01/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | APN.0992173 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |