Provider Demographics
NPI:1114475902
Name:NEWMAN, JESSICA L (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:140 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-228-2008
Mailing Address - Fax:276-228-5598
Practice Address - Street 1:140 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-228-2008
Practice Address - Fax:276-228-5598
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily