| Doctor Name: | SANDRA NEWSOM |
| NPI Number: | 1912901521 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | R852706 |
| Business Practice Address: | 2906 Goodman Rd W Suite 109 Horn Lake, MS - 386371291 |
| Business Phone Number: | 6623938022 |
| Business Fax Number: | 6623938052 |
| Mailing Address: | 2906 Goodman Rd W, Suite 109 HORN LAKE |
| State: | MS |
| Postal Code: | 386371291 |
| Phone Number: | 6623938022 |
| Fax Number: | 6623938052 |
| NPI Enumeration Date: | 06/10/2005 |
| NPI Last Update Date: | 10/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R852706 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |