Provider Demographics
NPI:1588297972
Name:ALDRIDGE, WAKETTA LASHELLE (APRN)
Entity type:Individual
Prefix:
First Name:WAKETTA
Middle Name:LASHELLE
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 TAYLOR MCQUEEN PL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9363
Mailing Address - Country:US
Mailing Address - Phone:870-273-4010
Mailing Address - Fax:
Practice Address - Street 1:300 CORRECTIONS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-8008
Practice Address - Country:US
Practice Address - Phone:870-523-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122838363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology