MEDICARE: KASANDRA NEWTON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1417749862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASANDRA NEWTON

Provider Business Mailing Address
First Line	:	5320 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5387
Country	:	US
Telephone Number	:	682-900-1444
Fax Number	:	432-322-4597

Provider Business Practice Location Address
First Line	:	5320 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5387
Country	:	US
Telephone Number	:	682-900-1444
Fax Number	:	432-322-4597

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

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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Directions to “ KASANDRA NEWTON ” Practice Location

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