Provider Demographics
NPI:1255752861
Name:NEWSOME-DEEL, KATIE (APRN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:NEWSOME-DEEL
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-0729
Mailing Address - Country:US
Mailing Address - Phone:276-979-9899
Mailing Address - Fax:276-979-9798
Practice Address - Street 1:386 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-2465
Practice Address - Country:US
Practice Address - Phone:276-979-9899
Practice Address - Fax:276-979-9798
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010249363LF0000X
VA0024171336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024171336OtherFNP