Healthcare Provider Details

I. General information

NPI: 1568054302
Provider Name (Legal Business Name): CHANGRIA YVETTE NEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 SADDLE CLUB WAY
LEXINGTON KY
40504-1694
US

IV. Provider business mailing address

1775 MCCULLOUGH DR APT 8
LEXINGTON KY
40511-1565
US

V. Phone/Fax

Practice location:
  • Phone: 859-421-0290
  • Fax:
Mailing address:
  • Phone: 859-494-8563
  • Fax:

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: