Individual
ANGELA D ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
561 ETHRIDGE LN, COXS CREEK, KY 40013-8857
(502) 262-7929
(833) 449-5151
Mailing address
PO BOX 37271, BELFAST, ME 04915-1214
(888) 488-8289
(833) 449-5151
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3006302
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000746393
ANTHEM
KY
01
—
50036061
PASSPORT HEALTH PLAN
KY
05
—
7100109880
—
KY
Enumeration date
12/16/2009
Last updated
05/08/2024
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