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MR. JACKIE WAYNE ETHERIDGE APRN, APMHNP
NPI 1740515790
Nurse Practitioner - Psychiatric/Mental Health in Pineville, LA

Active since October 08, 2009
242 WEST SHAMROCK, UNIT 1, PINEVILLE, LA 71360(318) 484-6850 Get Directions Write a Review

NPPES record last updated: October 8, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Jackie Wayne Etheridge Aprn, Apmhnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JACKIE WAYNE ETHERIDGE APRN, APMHNP (NPI 1740515790) is an individual psychiatric/mental health provider in Pineville, Louisiana, licensed in Louisiana (AP05657) and active in the NPI registry since October 2009.

NPPES Registry Identity

NPI1740515790
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameMR. JACKIE WAYNE ETHERIDGECredential: APRN, APMHNP
Location Address242 WEST SHAMROCK, UNIT 1Pineville, LA 71360
Mailing AddressPo Box 7473Alexandria, LA 71306-7473 · (318) 484-6850 · Fax (318) 484-6844
Phone(318) 484-6850
Sole ProprietorNo
Enumeration DateOctober 8, 2009
✔ NPI 1740515790 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in LA · AP05657
242 WEST SHAMROCK, UNIT 1, Pineville, LA 71360
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Other Names 1

Other Name (5)Mr. Jack Wayne Etheridge Aprn, Apmhnp

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackie Etheridge's NPI number?

The NPI number for Jackie Etheridge is 1740515790. It was assigned to this individual provider in the NPPES registry on October 8, 2009. The provider is also known as Mr. Jack Wayne Etheridge Aprn, Apmhnp.

Where is Jackie Etheridge located?

Jackie Etheridge practices at 242 West Shamrock, Unit 1, Pineville, LA 71360. The listed phone number is (318) 484-6850.

What is Jackie Etheridge's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Jackie Etheridge was last updated on October 8, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.