Provider Demographics
NPI:1437568003
Name:NEWSOM, DONTE JAMAL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DONTE
Middle Name:JAMAL
Last Name:NEWSOM
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 JOHNSON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1378
Mailing Address - Country:US
Mailing Address - Phone:304-842-3993
Mailing Address - Fax:304-842-4083
Practice Address - Street 1:1370 JOHNSON AVE STE 202
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1378
Practice Address - Country:US
Practice Address - Phone:304-842-3993
Practice Address - Fax:304-842-4083
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN80718-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily