Healthcare Provider Details

I. General information

NPI: 1922991777
Provider Name (Legal Business Name): RAYETTA M NEWBERRY FNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 631
DORAN VA
24612-0631
US

IV. Provider business mailing address

PO BOX 631
DORAN VA
24612-0631
US

V. Phone/Fax

Practice location:
  • Phone: 276-202-4344
  • Fax:
Mailing address:
  • Phone: 276-202-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193193
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: