Provider Demographics
NPI:1053467589
Name:NEWMAN, CAROLYN M (APN-BC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 S MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-7464
Mailing Address - Country:US
Mailing Address - Phone:731-424-9741
Mailing Address - Fax:731-427-5241
Practice Address - Street 1:219 S MISSOURI ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7464
Practice Address - Country:US
Practice Address - Phone:731-422-6630
Practice Address - Fax:731-935-2866
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12817OtherTLC
TN3702839Medicaid
TN3141680OtherBCBS
TN3901479Medicare ID - Type Unspecified
TN12817OtherTLC