Provider Demographics
NPI:1871151001
Name:NEWCOM, VICTORIA DANIELLE (APRN, FNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DANIELLE
Last Name:NEWCOM
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:500 N KEENE ST
Practice Address - Street 2:STE 305
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8370
Practice Address - Country:US
Practice Address - Phone:573-882-5673
Practice Address - Fax:573-884-0380
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019000709OtherAPRN