| Doctor Name: | MR. JOSEPH MICHAEL EASTRIDGE |
| NPI Number: | 1518270644 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | 687520 |
| Business Practice Address: | 2101 Fm 369 N Iowa Park, TX - 763676568 |
| Business Phone Number: | 9408557477 |
| Business Fax Number: | |
| Mailing Address: | 4503 Kenwood St, WICHITA FALLS |
| State: | TX |
| Postal Code: | 763102031 |
| Phone Number: | 9409234518 |
| Fax Number: | |
| NPI Enumeration Date: | 07/19/2010 |
| NPI Last Update Date: | 07/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 687520 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |