Provider Demographics
NPI:1922991777
Name:NEWBERRY, RAYETTA M (FNP, BC)
Entity type:Individual
Prefix:
First Name:RAYETTA
Middle Name:M
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:FNP, BC
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 631
Mailing Address - Street 2:
Mailing Address - City:DORAN
Mailing Address - State:VA
Mailing Address - Zip Code:24612-0631
Mailing Address - Country:US
Mailing Address - Phone:276-202-4344
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 631
Practice Address - Street 2:
Practice Address - City:DORAN
Practice Address - State:VA
Practice Address - Zip Code:24612-0631
Practice Address - Country:US
Practice Address - Phone:276-202-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024193193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily