Provider Demographics
NPI:1487633426
Name:NEWSOME, DAMON JR (PA)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:NEWSOME
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:940 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9251
Practice Address - Country:US
Practice Address - Phone:606-298-3412
Practice Address - Fax:606-298-5123
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY24870363AM0700X
NY024870363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000524189OtherBCBS
NYQ00328306OtherRAILROAD
KY95004933Medicaid
NY000559736001OtherBCBS HIGHMARK
NY07268739Medicaid
P00176973OtherRAILROAD