Healthcare Provider Details

I. General information

NPI: 1215883616
Provider Name (Legal Business Name): MALLORIE STEWART NEWMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 NESBITT RDG
LAKE LURE NC
28746-0057
US

IV. Provider business mailing address

146 NESBITT RDG
LAKE LURE NC
28746-0057
US

V. Phone/Fax

Practice location:
  • Phone: 828-625-4400
  • Fax:
Mailing address:
  • Phone: 828-625-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: