Healthcare Provider Details

I. General information

NPI: 1952756488
Provider Name (Legal Business Name): RHIANNON NEWSOM NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 22ND PL
LUBBOCK TX
79410-1315
US

IV. Provider business mailing address

4602 88TH ST
LUBBOCK TX
79424-4108
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-3715
  • Fax:
Mailing address:
  • Phone: 806-789-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0316734
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: