Vitality Mobile Wound Care LLC
NPI 1811876824ActiveOrganization· Nurse Practitioner, Family· Tyler, TX
Nurse Practitioner, Family in Tyler, Texas, registered in NPPES in September 2025. The authorized official on file is Christopher Lamar Ethridge, Ceo. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1811876824 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 2, 2025 |
| Last updated in NPPES | Jun 8, 2026 |
| Certified by provider | Jun 8, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Family Primary | 363LF0000X | — | — |
| Registered Nurse, Wound Care | 163WW0000X | — | — |
| Family Medicine | 207Q00000X | — | — |
| Nurse Practitioner | 363L00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TX) |
|---|
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