Provider Demographics
NPI:1093847956
Name:NEWMAN, KRISTA DEANNE (PAC)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:DEANNE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MARY LN
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2924
Mailing Address - Country:US
Mailing Address - Phone:910-654-2050
Mailing Address - Fax:910-654-0570
Practice Address - Street 1:7595 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5417
Practice Address - Country:US
Practice Address - Phone:303-594-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COP0005632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant