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General NPI Number Information
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NPI Number | 1124456736
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Entity Type | Individual
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Provider Name | CARLY NEWTON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 14805 NORTH OUTER 40 RD STE 320
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City | CHESTERFIELD
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State | MO
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Zip | 63017-6060
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Country | US
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Telephone | 636-536-0183
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Fax | 636-536-0526
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Provider Business Mailing Address
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Address Line | 3785 WATERLOO RD
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City | WATERLOO
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State | IL
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Zip | 62298-4409
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Country | US
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Telephone | 618-409-9900
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2014001970
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209019723
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License Number State | IL
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