Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP139312 | TX |
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP139312 | TX |
NPI | 1003382037 |
---|---|
Provider Name | Mrs. Ukisha Newsome |
First Address | Missouri City, TX 77459-1198 |
Second Address | Deer Park, TX 77536-5078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2018 |
Last Update Date | 09/04/2021 |