Individual provider · Type 1 NPI
Jackie Wayne Etheridge, APRN, APMHNP
Psychiatric/Mental Health Nurse Practitioner · Pineville, LA
NPI number
1740515790
Active
Practice location
242 West Shamrock, Unit 1
Pineville, LA 71360
Mailing address
PO Box 7473
Alexandria, LA 71306-7473
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | AP05657 (LA) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1740515790
Jackie Wayne Etheridge, APRN, APMHNP's National Provider Identifier is 1740515790, issued on Oct 8, 2009. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Pineville, LA. The record was last updated on Oct 8, 2009.