Provider Demographics
NPI:1396019501
Name:NEWSOME, JODI (NP-WCC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:NP-WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MAPLE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-9679
Mailing Address - Country:US
Mailing Address - Phone:859-240-3343
Mailing Address - Fax:
Practice Address - Street 1:13 MAPLE VALLEY LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-9679
Practice Address - Country:US
Practice Address - Phone:859-240-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12947363LA2100X
OHCOA.12947-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care