Healthcare Provider Details

I. General information

NPI: 1932997749
Provider Name (Legal Business Name): JOSHUA JERMAINE NEWSOME CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PERRY HILL RD STE 575
MONTGOMERY AL
36109-3630
US

IV. Provider business mailing address

100 PERRY HILL RD STE 575
MONTGOMERY AL
36109-3630
US

V. Phone/Fax

Practice location:
  • Phone: 256-470-3037
  • Fax:
Mailing address:
  • Phone: 256-470-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-136612
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: