Individual
CAMERON KEITH ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
2308B W HIGHWAY 66, STROUD, OK 74079-6729
(918) 968-4469
(918) 987-1622
Mailing address
PO BOX 777, STROUD, OK 74079-0777
(918) 290-9216
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
121857
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200829490A
—
OK
Enumeration date
02/08/2019
Last updated
09/30/2020
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