SAMANTHA KAYE ETHRIDGE (NPI# 1417355819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417355819 |
| Entity Type | Individual |
| Full Name | SAMANTHA KAYE ETHRIDGE |
| Other Name | SAMANTHA KAYE GAMMEL |
| Credential | PA |
| Practice Address |
1800 Gurley Ln Waco TX 76706-4025 |
| Mailing Address |
1600 Providence Dr Waco TX 76707-2261 |
| Practice Telephone | 2543136000 |
| Practice Fax Number | 2543136099 |
| Mailing Telephone | 2543134200 |
| Mailing Fax Number | 2543134326 |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2016-11-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA09447 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1800 GURLEY LN |
| City | WACO |
| State | TX |
| Zip Code | 76706-4025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699915066 | Josephine Escasa Watson | Family Medicine | 1800 Gurley Ln, Waco, TX 76706-4025 | 2009-02-25 |
| 1699096503 | Heart of Texas Community Health Center, Inc | Family Medicine | 1800 Gurley Ln, Waco, TX 76706-4025 | 2010-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104432632 | Jennifer Podrebarac | Counselor | 2010 Lasalle Ave, Ste B, Waco, TX 76706 | 2020-09-21 |
| 1629604186 | Lisa Grady | Counselor | 2010 Lasalle Ave, Suite A, Waco, TX 76706 | 2020-03-17 |
| 1699333096 | Magnolia Home Health LLC | Home Health | 635 N Robinson Dr Ste D, Robinson, TX 76706 | 2019-05-31 |
| 1669954863 | Lezlie Athey | Physical Therapy Assistant | 2997 Palomino Trail, Robinson, TX 76706 | 2018-09-04 |
| 1588144273 | David Allen Sulsh | Dentist | 421 N. Robinson Dr., Robinson, TX 76706 | 2018-08-21 |
| 1871942938 | Premier Er Plus - Waco, LLC | Clinic/Center | 221 N Jack Kultgen Expy, Suite 100, Waco, TX 76706 | 2016-06-09 |
| 1770970667 | Grant Louis Bargender | Specialist/Technologist | 1500 S. University Parks Dr, Baylor Athletic Training, Waco, TX 76706 | 2015-04-19 |
| 1376890533 | Focus Behavioral Associates, LLC | Behavioral Analyst | 635 N. Robinson Drive, Suite #k, Robinson, TX 76706 | 2012-08-07 |
| 1700113750 | Sheila A Luttrull | Nurse Practitioner | 1127 Ross Ave., Waco, TX 76706 | 2009-11-12 |
| 1386854065 | Social Work Connection | Case Management | 680 Apple Cross Court, Robinson, TX 76706 | 2007-05-23 |
| Find all providers in zip 76706 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245871052 | Elizabeth Leverson | Physician Assistant | 3912 Austin Ave, Waco, TX 76710-7127 | 2019-10-02 |
| 1063763225 | Jamie Lynn Laird | Physician Assistant | 5400 Crosslake Pkwy Ste 300, Waco, TX 76712 | 2012-09-27 |
| 1215116652 | Michael Paul Fichter Jr. | Physician Assistant | 7125 New Sanger Rd Ste A, Waco, TX 76712-4054 | 2007-11-02 |
| 1710090170 | Anthony B Balchunas | Physician Assistant | 601 W State Hwy 6, Ste 105, Waco, TX 76710-5575 | 2006-08-17 |
| 1902814544 | Fara Lynn Crawford | Physician Assistant | 6600 Fish Pond Rd Ste 101, Waco, TX 76710-2582 | 2006-08-03 |
| 1316966286 | Donald Eugene Hicks | Physician Assistant | 4205 Franklin Ave, Waco, TX 76710 | 2006-07-19 |
| 1497711105 | Mark D Roberts | Physician Assistant | 1201 Hewitt Dr Ste 203, Waco, TX 76712-8834 | 2006-04-21 |
| 1073577953 | Richard James Hecker | Physician Assistant | 1226 Washington Ave, Waco, TX 76701-1127 | 2006-04-17 |
| 1669448718 | Patricia Ann Goaley | Physician Assistant | 1445 Stillwater Rd, Waco, TX 76708-7612 | 2006-02-28 |
| 1992771927 | Ashley Glover Baker | Physician Assistant | 50 Hillcrest Medical Blvd Ste 206, Waco, TX 76712-8954 | 2006-02-28 |
| Find all providers in WACO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.