MR. JACKIE WAYNE ETHERIDGE (NPI# 1740515790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1740515790 |
Entity Type | Individual |
Full Name | MR. JACKIE WAYNE ETHERIDGE |
Other Name | MR. JACK WAYNE ETHERIDGE |
Credential | APRN, APMHNP |
Practice Address |
242 West Shamrock, Unit 1 Pineville LA 71360 |
Mailing Address |
Po Box 7473 Alexandria LA 71306-7473 |
Practice Telephone | 3184846850 |
Mailing Telephone | 3184846850 |
Mailing Fax Number | 3184846844 |
Enumeration Date | 2009-10-08 |
Last Update Date | 2009-10-08 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP05657 | LA | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
242 WEST SHAMROCK, UNIT 1 |
City | PINEVILLE |
State | LA |
Zip Code | 71360 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578110789 | Reneisha Armonii Roberts | Pharmacist | 3100 La-28, Pineville, LA 71360 | 2019-08-22 |
1396303145 | Tina Marie Lawhorn | Nurse Practitioner | 2945 Shreveport Hwy, Pineville, LA 71360 | 2019-06-05 |
1942773213 | Tioga Pharmacy LLC | Pharmacy | 5101 Shreveport Hwy, Pineville, LA 71360 | 2019-01-09 |
1649755497 | Jessica Wooten | Nurse Practitioner | 292 Jerry Lofton Rd, Pineville, LA 71360 | 2018-09-27 |
1215421995 | Elizabeth Simon-clark | Counselor | Central La State Hospital Unit 6 Meadows Lane, Pineville, LA 71360 | 2018-06-18 |
1982116497 | Dm Properties of Rapides, LLC | Radiology | 2705 Highway 28 E Ste B, Pineville, LA 71360 | 2017-10-25 |
1508384587 | Marion Patrick Hazelton I | Counselor | Pathways Red River Treatment Center, 242 West Shamrock Ave Unit 6 Melody Lane, Pineville, LA 71360 | 2017-08-30 |
1669902557 | Jessica Williams | Social Worker | Unit 6 Wing A Meadow Lane, Pineville, LA 71360 | 2017-06-14 |
1104365840 | Naomi Gates | Social Worker | 242 W Shamrock Unit 1, Pineville, LA 71360 | 2017-02-14 |
1861930224 | Sharon Humphrey | Counselor | 5400 Service Rd B206, Pineville, LA 71360 | 2017-02-06 |
Find all providers in zip 71360 |
Taxonomy Code | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1346897675 | Andrea Kaye Collins | Nurse Practitioner | 313 S Cherry St, Pineville, KY 40977-1724 | 2019-08-21 |
1912461914 | Yoshika Hayward | Nurse Practitioner | 2495 Shreveport Hwy, Pineville, LA 71360-4044 | 2019-01-24 |
1104200864 | Grace Runions | Nurse Practitioner | 850 Riverview Ave, Pineville, KY 40977-1452 | 2015-07-13 |
1124371406 | Sheila Marie Jones-jordan | Nurse Practitioner | 2495 Shreveport Hwy, 71 North, Pineville, LA 71360-4044 | 2012-10-23 |
1336499243 | Verena Pannell Mcginnis | Nurse Practitioner | 2495 Shreveport Hwy # 71, #116, Pineville, LA 71360-4044 | 2012-09-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1972113124 | Rebirth Mental Health Services LLC | Nurse Practitioner | 2116 Gause Blvd W Ste E, Slidell, LA 70460-4120 | 2020-08-03 |
1427668748 | Julie Susann Dyrek | Nurse Practitioner | 1 Lakeshore Dr Ste 1830, Lake Charles, LA 70629-0114 | 2020-08-01 |
1376169979 | Nancy Ariwodo | Nurse Practitioner | 225 Rue La France, Lafayette, LA 70508-1565 | 2020-06-19 |
1578183208 | Donald Glyn Gardner II | Nurse Practitioner | 324 Blue Fox Cir, Haughton, LA 71037-7707 | 2020-04-22 |
1629604129 | Raelyn Marie Plauche | Nurse Practitioner | 1951 Florida Ave Sw Ste D&e, Denham Springs, LA 70726-4947 | 2020-03-16 |
1962035964 | Tyler Trenton Wansley | Nurse Practitioner | 23515 Us-190, Mandeville, LA 70448 | 2020-02-18 |
1114558715 | Danielle J Threatts Aprn LLC | Nurse Practitioner | 208 W Gloria Switch Rd Ste 219, Lafayette, LA 70507-3409 | 2020-02-01 |
1992359848 | Harold G Frizzell Psychiatric Services LLC | Nurse Practitioner | 300 Thompson Loop, Lafayette, LA 70506-2820 | 2019-07-29 |
1598227779 | Candyce Brown | Nurse Practitioner | 333 Dr Michael Debakey Dr Ste 220, Lake Charles, LA 70601-5888 | 2019-04-04 |
1659835346 | Cassandra Thomas-jingles Psychiatric Nurse Practitioner, LLC. | Nurse Practitioner | 156 Mcgehee Dr, Baton Rouge, LA 70815-5012 | 2019-01-26 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.