Healthcare Provider Details

I. General information

NPI: 1750871497
Provider Name (Legal Business Name): KAELYN NEWTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 MEMORIAL CIR
CLARKSVILLE TN
37043-4539
US

IV. Provider business mailing address

3804 MCDAGIN CIR # A
FORT CAMPBELL KY
42223-3818
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7302
  • Fax: 931-920-7302
Mailing address:
  • Phone: 910-379-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: