Provider Demographics
NPI:1376705954
Name:ETHERIDGE, CHRISTINA JOY
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:JOY
Last Name:ETHERIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 TARA CT
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-7513
Mailing Address - Country:US
Mailing Address - Phone:270-527-0750
Mailing Address - Fax:
Practice Address - Street 1:127 TARA CT
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7513
Practice Address - Country:US
Practice Address - Phone:270-527-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications