Healthcare Provider Details

I. General information

NPI: 1811201510
Provider Name (Legal Business Name): DONNA NEWSOME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ROCKWOOD LN
HAZARD KY
41701-9415
US

IV. Provider business mailing address

PO BOX 700 3367 HWY 119 N
MAYKING KY
41837-0700
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-5761
  • Fax: 606-436-5797
Mailing address:
  • Phone: 606-436-5761
  • Fax: 606-436-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: