Healthcare Provider Details

I. General information

NPI: 1063061851
Provider Name (Legal Business Name): TERESA ANN NEWMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA ANN NEWMAN RN

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 STATE ROUTE 810 S
KUTTAWA KY
42055-6757
US

IV. Provider business mailing address

3672 STATE ROUTE 810 S
KUTTAWA KY
42055-6757
US

V. Phone/Fax

Practice location:
  • Phone: 270-908-9048
  • Fax: 270-632-4201
Mailing address:
  • Phone: 270-908-9048
  • Fax: 270-632-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: