Provider Demographics
NPI:1801939558
Name:NEW, NELDA FAYE (PHD, APRN, FNP)
Entity type:Individual
Prefix:DR
First Name:NELDA
Middle Name:FAYE
Last Name:NEW
Suffix:
Gender:F
Credentials:PHD, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3613
Mailing Address - Country:US
Mailing Address - Phone:501-730-8141
Mailing Address - Fax:
Practice Address - Street 1:805 OAK STREET
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-504-2329
Practice Address - Fax:501-504-2309
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR015886163W00000X
ARA01040363LF0000X
ARA001040363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148136758Medicaid
AR148136758Medicaid
ARP63562Medicare UPIN