Individual provider Active NPI

Marci Christine Etheridge, FNP-C

  • Family Nurse Practitioner
  • Henderson, NV
National Provider Identifier
1720495112
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN002264 Issued in NV
Practice address
8 Sunset Way Ste 108
Henderson, NV 89014-2053
Phone
(702) 458-3738
Fax
(702) 447-1939
NPI assigned
Jul 17, 2014
Last updated
Jan 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 18893 TN
Family Nurse Practitioner 363LF0000X APRN002264 NV Primary
General Practice Registered Nurse 163WG0000X RN89058 NV

Addresses

Primary practice location

8 Sunset Way Ste 108
Henderson, NV 89014-2053

Mailing address

828 E Flamingo Rd Apt 337
Las Vegas, NV 89119-7314
Phone (615) 738-0944

Other practice location 1

500 N Rainbow Blvd Ste 203
Las Vegas, NV 89107-1084
Phone (702) 259-1228

Other practice location 2

480 W Bonanza Rd Bldg 4
Las Vegas, NV 89106-3227
Phone (702) 458-3738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160826000754 NV Practitioner - Nurse Practitioner 9436371127 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
18893TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shadow Emergency Physicians PLLC Nurse Practitioner CurrentSince Aug 1, 2016 Accepting new patients
Shadow Emergency Physicians PLLC Nurse Practitioner CurrentSince Aug 1, 2016 Accepting new patients
Doctors Medical Services, Emcare PastSince Feb 1, 2021 Accepting new patients

Locations

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1405555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1720495112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 E FLAMINGO RD APT 337",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197314",
            "telephone_number": "615-738-0944",
            "fax_number": "000-000-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 SUNSET WAY STE 108",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890142053",
            "telephone_number": "702-458-3738",
            "fax_number": "702-447-1939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 N Rainbow Blvd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891071084",
            "country_code": "US",
            "telephone_number": "702-259-1228",
            "fax_number": "702-259-1252",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "480 W Bonanza Rd Bldg 4",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891063227",
            "country_code": "US",
            "telephone_number": "702-458-3738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "MARCI",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-17",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "18893",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "APRN002264",
            "primary": true
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "NV",
            "license": "RN89058",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.