Healthcare Provider Details

I. General information

NPI: 1588790109
Provider Name (Legal Business Name): KETOYIA C NEWKIRK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EASTWOOD DR
WALLACE NC
28466-9201
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-285-2330
  • Fax:
Mailing address:
  • Phone: 855-996-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103910
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: