Provider Demographics
NPI:1609959253
Name:NEWCOME, KATHRYN FARREN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:FARREN
Last Name:NEWCOME
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 E PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177
Mailing Address - Country:US
Mailing Address - Phone:304-727-0055
Mailing Address - Fax:304-388-3604
Practice Address - Street 1:3200 MACCORKLE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5559
Practice Address - Fax:304-388-3604
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30480163W00000X
WV47233367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0069179000Medicaid
WVNE7235641Medicare ID - Type UnspecifiedCAMC