Nicole Ethridge, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

701 Shadwell Ave
Flora, IL 62839-2310

Phone

(618) 662-8361

NPI assigned

Jul 19, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1658188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1922733484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11121 E CANDLEBERRY AVE",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624017456",
            "telephone_number": "618-363-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SHADWELL AVE",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628392310",
            "telephone_number": "618-662-8361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "NICOLE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-19",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gayla Kay Dunaway, OTR/L
• Delaney Elliott, RN
• Eileen Mary Enlow, RN
• Gayle Loar Erxleben, APN
• Karli Jo Eskew, RN
• Kaylee Flood, M.S. CCC-SLP
• Flora Chiropractic LLC
• Flora Comm Unit SCH Dist 35
• Flora Pavilion Nursing Home Center, Inc
• McKenzi Frederick, RN

• Physical Therapy Assistant in Flora, IL
• Providers in Flora, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.