MEDICARE: BRANDON DESEAN NEWKIRK QMHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1003490681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON DESEAN NEWKIRK QMHA

Provider Business Mailing Address
First Line	:	4200 S VALLEY VIEW BLVD UNIT 1035J
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4031
Country	:	US
Telephone Number	:	910-747-7179
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 S VALLEY VIEW BLVD UNIT 1035J
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4031
Country	:	US
Telephone Number	:	910-747-7179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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Directions to “ BRANDON DESEAN NEWKIRK QMHA” Practice Location

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