Provider Demographics
NPI:1780017616
Name:NEWCOMER, NICOLE R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:R
Last Name:NEWCOMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 NW FIELDING RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-2651
Mailing Address - Country:US
Mailing Address - Phone:785-270-0047
Mailing Address - Fax:
Practice Address - Street 1:4505 NW FIELDING RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2651
Practice Address - Country:US
Practice Address - Phone:785-270-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76114363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002247OtherMEDICARE PTAN
KS201085010CMedicaid