Healthcare Provider Details

I. General information

NPI: 1134046766
Provider Name (Legal Business Name): JESSICA NEWSAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 WOODMAN DR
DAYTON OH
45420-1143
US

IV. Provider business mailing address

695 MEMORIAL DR
XENIA OH
45385-9027
US

V. Phone/Fax

Practice location:
  • Phone: 397-298-4417
  • Fax:
Mailing address:
  • Phone: 937-298-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: