Healthcare Provider Details

I. General information

NPI: 1265356117
Provider Name (Legal Business Name): YASMINE NEWSOME
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 CLIFF CAMERON DR
CHARLOTTE NC
28269-5906
US

IV. Provider business mailing address

5903 HUNTERS CROSSING LN
CHARLOTTE NC
28215-1976
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-6622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number000029695241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: