Provider Demographics
NPI:1386671519
Name:NEWTON, DEDRA MILLER (FNP)
Entity Type:Individual
Prefix:
First Name:DEDRA
Middle Name:MILLER
Last Name:NEWTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9632
Mailing Address - Country:US
Mailing Address - Phone:225-767-8550
Mailing Address - Fax:225-767-8556
Practice Address - Street 1:4660 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9632
Practice Address - Country:US
Practice Address - Phone:225-767-8550
Practice Address - Fax:225-767-8556
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1477761Medicaid
LAQ49721Medicare UPIN
LA4H572Medicare ID - Type Unspecified