Healthcare Provider Details

I. General information

NPI: 1285541060
Provider Name (Legal Business Name): RANDY JOE NEWELL JR. CPNP-PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 N ELM ST STE 300
GREENSBORO NC
27401-6312
US

IV. Provider business mailing address

1806 BLOOM ST
GREENSBORO NC
27410-3062
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-6161
  • Fax:
Mailing address:
  • Phone: 336-272-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5025034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: