Healthcare Provider Details

I. General information

NPI: 1003495938
Provider Name (Legal Business Name): CHARISSA MONIQUE NEWKIRK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEIL AVE
COLUMBUS OH
43201-2333
US

IV. Provider business mailing address

1640 NEIL AVE
COLUMBUS OH
43201-2333
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-5766
  • Fax: 614-688-3440
Mailing address:
  • Phone: 614-292-5766
  • Fax: 614-688-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.153352
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: