Angela D Ethridge, ARNP
Individual provider Active NPI Family Nurse Practitioner · Coxs Creek, KY
NPI 1619206885 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1619206885
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 3006302 (KY)
- Practice address
- 561 Ethridge LN
Coxs Creek, KY 40013-8857 - Phone
- (502) 262-7929
- Fax
- (833) 449-5151
- NPI assigned
- Dec 16, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
561 Ethridge LN
Coxs Creek, KY 40013-8857
Phone (502) 262-7929
Hospital & facility affiliations
- Hosparus, Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100129000279 | KY | Practitioner - Nurse Practitioner | 5395888382 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Angie Ethridge Aprn PLLC | Family | Current |
Accepting new patients |
| Hosparus Palliative Care Inc. | Past | Accepting new patients |
Locations
3625 Fern Valley Rd
Louisville, KY 40219
Phone (502) 262-5172
7504 Westport Rd
Louisville, KY 40222
Phone (502) 693-2681
Interoperability endpoints
- angela.ethridge.1@29428.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 3006302 | KY | Yes |
Addresses
Primary practice location
561 Ethridge LN
Coxs Creek, KY 40013-8857
Mailing address
PO Box 37271
Belfast, ME 04915-1214
Phone (888) 488-8289
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000746393 | Other | KY | ANTHEM |
| 7100109880 | Medicaid | KY | |
| 50036061 | Other | KY | PASSPORT HEALTH PLAN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | angela.ethridge.1@29428.direct.athenahealth.com |
Other providers in Coxs Creek, KY
- Angie Ethridge Aprn PLLC
- Sara Ballard
- Shirley Liao Barker
- Judith L. Cooke
- Jacqueline Beatrice Dale
- Jennifer Fenwick
- Kaitlyn Doris Pate
- Pathway to Potential Occupational Therapy
- Michaela Petsy
- Kaylee Brooke Reynolds
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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.