Provider Demographics
NPI:1568054302
Name:NEWELL, CHANGRIA YVETTE
Entity Type:Individual
Prefix:
First Name:CHANGRIA
Middle Name:YVETTE
Last Name:NEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 MCCULLOUGH DR APT 8
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1565
Mailing Address - Country:US
Mailing Address - Phone:859-494-8563
Mailing Address - Fax:
Practice Address - Street 1:1324 SADDLE CLUB WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1694
Practice Address - Country:US
Practice Address - Phone:859-421-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider