Angie Ethridge Aprn PLLC
Organization Active NPI Family Nurse Practitioner · Coxs Creek, KY
NPI 1548638240 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1548638240
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- ANGIE ETHRIDGE APRN PLLC
- Practice address
- 561 Ethridge LN
Coxs Creek, KY 40013-8857 - Phone
- (502) 262-7929
- Fax
- (833) 449-5151
- NPI assigned
- Sep 11, 2015
- Organization subpart
- No
Authorized official
- Name
- Angela D Ethridge, APRN
- Title
- Owner
- Phone
- (502) 262-7929
Practitioners 1
-
Angela D Ethridge, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150924001558 | KY | Part B Supplier - Clinic/Group Practice | 8820306848 |
Receives reassigned benefits from 1 practitioner Practice locations: Coxs Creek, KY |
National Provider Directory
Interoperability endpoints
- angela.ethridge.1@29428.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
561 Ethridge LN
Coxs Creek, KY 40013-8857
Mailing address
PO Box 37271
Belfast, ME 04915-1214
Phone (502) 262-7929
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100380730 | Medicaid | KY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | angela.ethridge.1@29428.direct.athenahealth.com |
Other providers in Coxs Creek, KY
All providers in Coxs Creek, KY · Family Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.