Provider Demographics
NPI:1104836089
Name:NEWTON, REBECCA CALLIE (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CALLIE
Last Name:NEWTON
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 1:100 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-9775
Mailing Address - Country:US
Mailing Address - Phone:859-229-6740
Mailing Address - Fax:859-258-4243
Practice Address - Street 1:100 VETERANS DR
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-9775
Practice Address - Country:US
Practice Address - Phone:859-858-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA188363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95001889Medicaid
KY95001889Medicaid
0621344Medicare ID - Type Unspecified
KY0169Medicare PIN