Healthcare Provider Details

I. General information

NPI: 1487968103
Provider Name (Legal Business Name): ANTHONY NEWSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 W SERVICE DR
COLDWATER MS
38618-3822
US

IV. Provider business mailing address

643 W SERVICE DR
COLDWATER MS
38618-3822
US

V. Phone/Fax

Practice location:
  • Phone: 662-233-5200
  • Fax: 662-624-4354
Mailing address:
  • Phone: 662-624-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR868252
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: