Jennifer Simpson Etheridge

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN222355 Issued in GA

Practice address

1360 Caduceus Way Ste 105
Watkinsville, GA 30677-7300

Phone

(706) 850-3795

Fax

(877) 580-1676

NPI assigned

Jan 22, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1144784372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 CADUCEUS WAY STE 105",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777300",
            "telephone_number": "706-850-3795",
            "fax_number": "877-580-1676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 CADUCEUS WAY STE 105",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777300",
            "telephone_number": "706-850-3795",
            "fax_number": "877-580-1676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1199 Prince Ave",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306062797",
            "country_code": "US",
            "telephone_number": "706-475-7000 x3437",
            "fax_number": "706-475-7671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "JENNIFER",
        "middle_name": "SIMPSON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-22",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN222355",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN222355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Amber England, L.P.C.
• Patricia Grace Ennis, MOTR/L
• Christian A Ericson, MD
• Daphne C Esho, MD
• Amanda Estep, APC
• Mindy Etienne, RBT
• Gretchen Fennell Evans, FNP
• Heather Evans, MA, BCBA
• Lexie Evans, RBTS
• Vickie Adams Evans, RPH

• Adult Health Nurse Practitioner in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.