MEDICARE: PATRICIA B NEWCOMB PHD RN CPNP

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	363LP0200X	Pediatric Nurse Practitioner	510094	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00U87Z	OTHER	TX	MEDICARE GROUP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	137345810	OTHER	TX	CSHCN GROUP TPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1750369203	OTHER	TX	NPI GROUP NUMBER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	062615205	OTHER	TX	CSHCN INDIVIDUAL TPI

General Provider Information

NPI Number	:	1366447013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA B NEWCOMB PHD RN CPNP

Provider Business Mailing Address
First Line	:	PO BOX 99371
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76199-0371
Country	:	US
Telephone Number	:	682-885-1855
Fax Number	:	682-885-7347

Provider Business Practice Location Address
First Line	:	2528 JACKSBORO HWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-2206
Country	:	US
Telephone Number	:	817-625-1770
Fax Number	:	817-625-1287

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

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	05/20/2010

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