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NPI Code Detail

MEDICARE: VICTORIA JASMINE MARIE NEWSOME

MEDICARE: VICTORIA JASMINE MARIE NEWSOME
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
1363LF0000XFamily Nurse Practitioner110997WV
2163W00000XRegistered Nurse110997WV
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1447046412
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA JASMINE MARIE NEWSOME
Provider Business Mailing Address
First Line : PO BOX 25
Second Line :
City : ACCOVILLE
State : WV
Zip : 25606-0025
Country : US
Telephone Number : 304-601-6226
Fax Number :
Provider Business Practice Location Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1398
Country : US
Telephone Number : 304-766-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2025
Last Update Date : 09/08/2025

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Directions to “ VICTORIA JASMINE MARIE NEWSOME ” Practice Location

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