Provider Demographics
NPI:1003490681
Name:NEWKIRK, BRANDON DESEAN (QMHA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DESEAN
Last Name:NEWKIRK
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 S VALLEY VIEW BLVD UNIT 1035J
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4031
Mailing Address - Country:US
Mailing Address - Phone:910-747-7179
Mailing Address - Fax:
Practice Address - Street 1:4200 S VALLEY VIEW BLVD UNIT 1035J
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4031
Practice Address - Country:US
Practice Address - Phone:910-747-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator