MEDICARE: KETOYIA C NEWKIRK PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1588790109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KETOYIA C NEWKIRK PA-C

Provider Business Mailing Address
First Line	:	PO BOX 80534
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27623-0534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 MINE LAKE CT STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6417
Country	:	US
Telephone Number	:	877-868-5351
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/11/2025

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