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General NPI Number Information
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NPI Number | 1295447894
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Entity Type | Individual
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Provider Name | TRACY KIMBERLY NEWMAN PMHNP, CNP, RN
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Gender | Female
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 7430 WENTWORTH AVE
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City | RICHFIELD
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State | MN
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Zip | 55423-4133
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Country | US
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Telephone | 612-488-0040
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Fax | 833-973-4055
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Provider Business Mailing Address
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Address Line | 376 COUNTY ROAD F E
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-6109
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Country | US
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Telephone | 651-491-5425
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP9811-2415705-36924
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License Number State | MN
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