Provider Demographics
NPI:1003806340
Name:NEWKIRK, ELIZABETH ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:NEWKIRK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WEST MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEWBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4220
Mailing Address - Country:US
Mailing Address - Phone:713-864-2733
Mailing Address - Fax:
Practice Address - Street 1:5656 KELLEY ST
Practice Address - Street 2:ROOM IEC 93006
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:713-566-5397
Practice Address - Fax:713-566-4711
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180433804OtherCSHCN
TX8Y0614OtherBCBSTX
TX180433803Medicaid
TX8L15995Medicare PIN
TX180433804OtherCSHCN
TX8J2900Medicare PIN
TX180433803Medicaid