Carly Newton, FNP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

209019723 Issued in IL

Practice address

14805 North Outer 40 Rd Ste 320
Chesterfield, MO 63017-6060

Phone

(636) 536-0183

Fax

(636) 536-0526

NPI assigned

Oct 16, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• Carly Gagnon Former name

Medicare fee-for-service enrollment

Enrolled in MO, IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Specialized Wound Management LLC

  • Adult Health Nurse Practitioner
  • Chesterfield, MO
  • NPI 1962430157

  IL

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1124456736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3785 WATERLOO RD",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622984409",
            "telephone_number": "618-409-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14805 NORTH OUTER 40 RD STE 320",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630176060",
            "telephone_number": "636-536-0183",
            "fax_number": "636-536-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWTON",
        "first_name": "CARLY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-16",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2014001970",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209019723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADULT NURSE PRACTITIONER",
            "identifier": "2014001970",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS STATE LICENSE FOR RN",
            "identifier": "041404932",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI STATE LICENSE FOR RN",
            "identifier": "2010022356",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADULT/FAMILY NURSE PRACTITIONER",
            "identifier": "209019723",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY NURSE PRACTITIONER",
            "identifier": "2019010533",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "GAGNON",
            "credential": "ANP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• New Hope Human Services
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• Lindsay Newman, OT
• Carol Elise Newmark, LCSW
• Adaoma Vera Ngari Egekeze, MD
• Hong Ngo, FNP-C
• Christopher Michael Nguyen, DO
• Linda Thi Nguyen, MA, RD, LD
• Julie Ann Nickerson

• Adult Health Nurse Practitioner in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.