Healthcare Provider Details

I. General information

NPI: 1114860970
Provider Name (Legal Business Name): STEPHANIE NICOLE NEWSOME PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 BLACKJACK RD
MOUNT VERNON OH
43050-9193
US

IV. Provider business mailing address

15793 GIRL SCOUT CAMP RD
UTICA OH
43080-9735
US

V. Phone/Fax

Practice location:
  • Phone: 740-397-0442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0041904
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: