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General NPI Number Information
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NPI Number | 1083436182
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Entity Type | Individual
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Provider Name | CARLY NEWSOME DC
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Gender | Female
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/18/2025
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Provider Practice Location Address
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Address Line | 4220 VALLEY RIDGE BLVD STE 106
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5173
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Country | US
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Telephone | 904-217-0361
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Fax |
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Provider Business Mailing Address
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Address Line | 10961 BURNT MILL RD APT 126
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4674
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Country | US
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Telephone | 904-217-0361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 15247
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License Number State | FL
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