Provider Demographics
NPI:1487968103
Name:NEWSON, ANTHONY (FNP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:NEWSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 W SERVICE DR
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-3822
Mailing Address - Country:US
Mailing Address - Phone:662-624-4292
Mailing Address - Fax:
Practice Address - Street 1:643 W SERVICE DR
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618-3822
Practice Address - Country:US
Practice Address - Phone:662-233-5200
Practice Address - Fax:662-624-4354
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR868252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07608218Medicaid
MS07608218Medicaid