JACKIE WAYNE ETHERIDGE

PINEVILLE, LA
NPI1740515790
Other NameJACK WAYNE ETHERIDGE
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: LA  AP05657)
Enumeration Date2009-10-08
Last Update Date2009-10-08
Business Address
Mr. JACKIE WAYNE ETHERIDGE APRN, APMHNP
242 WEST SHAMROCK, UNIT 1
PINEVILLE, LA 71360
Phone number: 318-484-6850
Mailing Address
Mr. JACKIE WAYNE ETHERIDGE APRN, APMHNP
PO BOX 7473
ALEXANDRIA, LA 71306-7473
Phone number: 318-484-6850
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