Individual
CARLY NEWTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
14805 NORTH OUTER 40 RD STE 320, CHESTERFIELD, MO 63017-6060
(636) 536-0183
(636) 536-0526
Mailing address
3785 WATERLOO RD, WATERLOO, IL 62298-4409
(618) 409-9900
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
2014001970
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
209019723
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041404932
ILLINOIS STATE LICENSE FOR RN
IL
01
—
2010022356
MISSOURI STATE LICENSE FOR RN
MO
01
—
2014001970
ADULT NURSE PRACTITIONER
MO
01
—
2019010533
FAMILY NURSE PRACTITIONER
MO
01
—
209019723
ADULT/FAMILY NURSE PRACTITIONER
IL
Enumeration date
10/16/2013
Last updated
09/18/2024
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