Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 41205 | KY |
NPI | 1306919311 |
---|---|
Provider Name | Tara J. Newsome |
First Address | Prestonsburg, KY 41653-0668 |
Second Address | Harold, KY 41635-7064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 20/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100004770 | (05) | KY |