Basic Information
Provider Information
NPI: 1073710042
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCBRIDE
FirstName: KARI
MiddleName: LYNN
NamePrefix: MRS.
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5100 JEFFRIES LN
Address2:  
City: NEWBURGH
State: IN
PostalCode: 476303053
CountryCode: US
TelephoneNumber: 8124906691
FaxNumber:  
Practice Location
Address1: 509 N CARRIER ST
Address2:  
City: MORGANFIELD
State: KY
PostalCode: 424371201
CountryCode: US
TelephoneNumber: 2703893513
FaxNumber: 2703894706
Other Information
ProviderEnumerationDate: 07/02/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000XAOO834KYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


Home