Individual
SANDRA NEWSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2906 GOODMAN RD W, SUITE 109, HORN LAKE, MS 38637-1291
(662) 393-8022
(662) 393-8052
Mailing address
3400 GOODMAN RD W, HORN LAKE, MS 38637-1174
(662) 393-8022
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R852706
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117535
—
MS
01
—
512I500595
MEDICARE PTAN
MS
Enumeration date
06/10/2005
Last updated
09/11/2019
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