Provider Demographics
NPI:1083779839
Name:NEWSOME, JEAN ANNA (RN CRNP)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ANNA
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:RN CRNP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2018 MEDICAL CENTER DR
Mailing Address - Street 2:PROFESSIONAL OFFICE BLDG SUITE 115
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-802-1430
Mailing Address - Fax:205-802-1343
Practice Address - Street 1:2018 MEDICAL CENTER DR
Practice Address - Street 2:PROFESSIONAL OFFICE BLDG SUITE 115
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-802-1430
Practice Address - Fax:205-802-1343
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1059725207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I500433Medicare UPIN