Provider Demographics
NPI:1770241515
Name:WHITFIELD, TYECHA NEWSOME
Entity Type:Individual
Prefix:
First Name:TYECHA
Middle Name:NEWSOME
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TYECHA
Other - Middle Name:MONE
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2111 NEUSE BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4318
Mailing Address - Country:US
Mailing Address - Phone:833-354-1492
Mailing Address - Fax:866-554-1804
Practice Address - Street 1:2111 NEUSE BLVD STE H
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4318
Practice Address - Country:US
Practice Address - Phone:833-354-1492
Practice Address - Fax:866-554-1804
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC292611163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse