Healthcare Provider Details

I. General information

NPI: 1366883621
Provider Name (Legal Business Name): JACQUELINE MCDARRY NEWSOME-WILLIAMS PH.D.RN,ANP-BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE
CLINTON MD
20735-1628
US

IV. Provider business mailing address

PO BOX 70861
BETHESDA MD
20813-0861
US

V. Phone/Fax

Practice location:
  • Phone: 202-558-0504
  • Fax: 202-558-0508
Mailing address:
  • Phone: 202-558-0504
  • Fax: 202-558-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1018191
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR187582
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN1018191
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: