Provider Demographics
NPI:1528584273
Name:NEWBERRY, DARA MADELINE (DNP, FNP-C, APRN)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:MADELINE
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:DNP, FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6027 WALNUT GROVE RD STE 312
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2128
Mailing Address - Country:US
Mailing Address - Phone:901-681-0778
Mailing Address - Fax:901-821-9987
Practice Address - Street 1:6029 WALNUT GROVE RD STE 209
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-681-0778
Practice Address - Fax:901-821-9987
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60810803363L00000X
MS904315363LF0000X
TN22883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS001177279Medicaid
TNQ059580Medicaid