Active NPI
Kristen Ethridge, NP
- Pediatric Nurse Practitioner
- Los Angeles, CA
National Provider Identifier
1487979001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 10455
- Practice address
- 10833 Le Conte Ave
Los Angeles, CA 90095-6062 - Phone
- (310) 825-9820
- NPI assigned
- Apr 7, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 342343 | CA | |
| Pediatric Nurse Practitioner | 363LP0200X | 10455 | CA | Primary |
Addresses
Primary practice location
10833 Le Conte Ave
Los Angeles, CA 90095-6062
Mailing address
5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (323) 361-4148
Other practice location 1
4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 361-4148
Other practice location 2
4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 361-4148
Other names 1
- Kristen Eistetter
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 342343 | CA | MD | Pediatric Nurse Practitioner |
Interoperability endpoints
- kethridge59166@direct.uclahealth.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1487979001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5767 W CENTURY BLVD STE 400",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900455631",
"telephone_number": "323-361-4148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10833 LE CONTE AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900956062",
"telephone_number": "310-825-9820"
}
],
"practiceLocations": [
{
"address_1": "4650 W Sunset Blvd",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900276062",
"country_code": "US",
"telephone_number": "323-361-4148",
"fax_number": "323-361-3668",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4650 W Sunset Blvd",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900276062",
"country_code": "US",
"telephone_number": "323-361-4148",
"fax_number": "323-361-3668",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ETHRIDGE",
"first_name": "KRISTEN",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-07",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CA",
"license": "342343",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CA",
"license": "10455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTEN",
"last_name": "EISTETTER",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.