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Individual

CHARLES ELDRIDGE III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP

Contact information

Practice address
5548 N FARMER BRANCH RD, OZARK, MO 65721-5315
(417) 322-6622
(417) 350-1935
Mailing address
3600 S NATIONAL AVE, SPRINGFIELD, MO 65807-7311
(417) 322-6622
(417) 350-1935

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2021022694
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
218639
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
281907758
AR
05
420097472
MO
Enumeration date
06/21/2021
Last updated
04/17/2023
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