Provider Demographics
NPI:1184230286
Name:NEWBERRY, PAGE AUGUSTA (APRN)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:AUGUSTA
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 W MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6791
Mailing Address - Country:US
Mailing Address - Phone:870-688-2907
Mailing Address - Fax:
Practice Address - Street 1:5302 W VILLAGE PKWY STE 3
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8139
Practice Address - Country:US
Practice Address - Phone:479-282-2737
Practice Address - Fax:877-671-7762
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR126229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner