Provider Demographics
NPI:1699245985
Name:NEWBY, ROSE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:NEWBY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-5752
Mailing Address - Country:US
Mailing Address - Phone:870-664-0028
Mailing Address - Fax:
Practice Address - Street 1:2540 STATE HIGHWAY 388
Practice Address - Street 2:
Practice Address - City:GOULD
Practice Address - State:AR
Practice Address - Zip Code:71643-9634
Practice Address - Country:US
Practice Address - Phone:870-850-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0000000000Medicaid