Active NPI
Carla Jean Ethridge, R.N.
- Religious Nonmedical Nursing Personnel
- Gilbert, AZ
National Provider Identifier
1376692053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Religious Nonmedical Nursing Personnel
- License
- RN064257
- Practice address
- 1016 N Burk St
Gilbert, AZ 85234-3473 - Phone
- (480) 892-6908
- Fax
- (480) 813-8240
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Religious Nonmedical Nursing Personnel | 374T00000X | RN064257 | AZ | Primary |
Addresses
Primary practice location
1016 N Burk St
Gilbert, AZ 85234-3473
Mailing address
1055 S Buchanan St
Gilbert, AZ 85233-8026
Phone (480) 786-1825
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN064257 | AZ | MD | Religious Nonmedical Nursing Personnel |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376692053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 S BUCHANAN ST",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852338026",
"telephone_number": "480-786-1825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1016 N BURK ST",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852343473",
"telephone_number": "480-892-6908",
"fax_number": "480-813-8240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETHRIDGE",
"first_name": "CARLA",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "374T00000X",
"taxonomy_group": "",
"desc": "Religious Nonmedical Nursing Personnel",
"state": "AZ",
"license": "RN064257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.