MEDICARE: MR. JOSEPH MICHAEL EASTRIDGE NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	687520	TX

General Provider Information

NPI Number	:	1518270644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MICHAEL EASTRIDGE NP-C

Provider Business Mailing Address
First Line	:	4503 KENWOOD ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-2031
Country	:	US
Telephone Number	:	940-923-4518
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 FM 369 N
Second Line	:
City	:	IOWA PARK
State	:	TX
Zip	:	76367-6568
Country	:	US
Telephone Number	:	940-855-7477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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