Healthcare Provider Details

I. General information

NPI: 1518858570
Provider Name (Legal Business Name): MICHELLE RENEE NEWSOM APRN-FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17766 VERDE PKWY STE 260
SELMA TX
78154-2224
US

IV. Provider business mailing address

112 HERFF RD STE 320
BOERNE TX
78006-2750
US

V. Phone/Fax

Practice location:
  • Phone: 210-495-7246
  • Fax: 210-495-7245
Mailing address:
  • Phone: 210-495-7246
  • Fax: 210-495-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1206440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: