Provider Demographics
NPI:1558466276
Name:NEWKIRK FAMILY PRACTICE CLINIC LLC
Entity Type:Organization
Organization Name:NEWKIRK FAMILY PRACTICE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRIXIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:NEWKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:972-279-6767
Mailing Address - Street 1:4725 GUS THOMASSON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1734
Mailing Address - Country:US
Mailing Address - Phone:972-279-6767
Mailing Address - Fax:972-279-3914
Practice Address - Street 1:4725 GUS THOMASSON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1734
Practice Address - Country:US
Practice Address - Phone:972-279-6767
Practice Address - Fax:972-279-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXI16636207Q00000X
TXG4442207R00000X
TX542807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS69344Medicare UPIN
TXI16636Medicare UPIN
TXC13129Medicare UPIN