Provider Demographics
NPI:1518586478
Name:NEWSOME, JUSTIN (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 MARKET PLACE CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-7400
Practice Address - Country:US
Practice Address - Phone:859-317-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28707363LF0000X
KY3014486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2019079870OtherNATIONAL CERTIFICATION
TN28707OtherAPRN LICENSE NUMBER
KY3014486OtherLICENSE NUMBER
AL3-000161OtherLICENSE NUMBER
VA0024180626OtherLICENSE NUMBER