Individual provider Active NPI

Kathleen Bride, CPT

  • Phlebotomy Technician
  • Marietta, GA
National Provider Identifier
1063306009
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Phlebotomy TechnicianTaxonomy code 246RP1900X
License
12115637 Issued in NY
Practice address
222 Robbie LN SW
Marietta, GA 30060-5459
Phone
(470) 439-8635
NPI assigned
Jun 4, 2025
Last updated
Jun 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebotomy Technician 246RP1900X 12115637 NY Primary

Addresses

Primary practice location

222 Robbie LN SW
Marietta, GA 30060-5459

Mailing address

222 Robbie LN SW
Marietta, GA 30060-5459
Phone (470) 439-8635

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
12115637NYMDPhlebotomy Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1063306009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 ROBBIE LN SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300605459",
            "telephone_number": "470-439-8635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 ROBBIE LN SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300605459",
            "telephone_number": "470-439-8635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDE",
        "first_name": "KATHLEEN",
        "credential": "CPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-06-04",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "NY",
            "license": "12115637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.