Basic Information
| Provider Information | |||||||||
| NPI: | 1003806340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWKIRK | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 WEST MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WEWBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138642733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5656 KELLEY ST | ||||||||
| Address2: | ROOM IEC 93006 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770261967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135665397 | ||||||||
| FaxNumber: | 7135664711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 08/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA03102 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 180433804 | 01 | TX | CSHCN | OTHER | 8Y0614 | 01 | TX | BCBSTX | OTHER | 180433803 | 05 | TX | MEDICAID |