Healthcare Provider Details

I. General information

NPI: 1356952402
Provider Name (Legal Business Name): LAKARA RAQUEL NEWTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 350
HOUSTON TX
77030-3004
US

IV. Provider business mailing address

6431 FANNIN ST # 3.286
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16177
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: