Provider Demographics
NPI:1366447013
Name:NEWCOMB, PATRICIA B (PHD RN CPNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:PHD RN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:2528 JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-2206
Practice Address - Country:US
Practice Address - Phone:817-625-1770
Practice Address - Fax:817-625-1287
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX510094363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherMEDICARE GROUP PIN
TX137345810OtherCSHCN GROUP TPI
TX062615204Medicaid
TX1750369203OtherNPI GROUP NUMBER
TX140442852OtherMEDICAID GROUP TPI
TX062615205OtherCSHCN INDIVIDUAL TPI
TX8L16806Medicare PIN
TX00U87ZOtherMEDICARE GROUP PIN