Healthcare Provider Details

I. General information

NPI: 1578494043
Provider Name (Legal Business Name): MELINDA SUE NEWPORT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 OFFICE PARK DR STE 200
KETTERING OH
45439-2295
US

IV. Provider business mailing address

1945 PUEBLO DR
XENIA OH
45385-4349
US

V. Phone/Fax

Practice location:
  • Phone: 937-802-5440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number543531
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: