1164801924 NPI number — MONICA NEWTON NP-C

Table of content: MONICA NEWTON NP-C (NPI 1164801924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164801924 NPI number — MONICA NEWTON NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWTON
Provider First Name:
MONICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164801924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37334-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-438-8260
Provider Business Mailing Address Fax Number:
931-438-8257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3051 BUFFALO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38464-6189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-673-6737
Provider Business Practice Location Address Fax Number:
800-474-4039
Provider Enumeration Date:
05/27/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APN0000019736 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)