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General NPI Number Information
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NPI Number | 1518586478
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Entity Type | Individual
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Provider Name | JUSTIN NEWSOME MSN, APRN, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 106 MARKET PLACE CIR
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City | GEORGETOWN
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State | KY
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Zip | 40324-7400
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Country | US
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Telephone | 859-317-6075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 932958
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City | CLEVELAND
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State | OH
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Zip | 44193-0028
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28707
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3014486
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License Number State | KY
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