Healthcare Provider Details

I. General information

NPI: 1699891879
Provider Name (Legal Business Name): KEVIN WILLIAM NEWBY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 W STONES CROSSING RD STE 100
GREENWOOD IN
46143-8558
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-1133
  • Fax: 317-837-4640
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000637A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: