Provider Demographics
NPI:1154416147
Name:NEWMAN, TERESA L (CPNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-870-7960
Practice Address - Fax:682-885-3858
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578623363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX180335501Medicaid
TX180337104OtherCSHCN INDIVIDUAL TPI
TX150220509OtherCSHCN GROUP TPI
TX00257TOtherMEDICARE GROUP PIN
TX137357OtherSUPERIOR PIN
TX180337101Medicaid
1750369203OtherGRP NPI NUMBER
TX2620939OtherUHC PIN
TX7581180OtherAETNA PIN
TX8Y0026OtherBCBSTX IND PIN
TX9820983OtherCIGNA PIN
TX150220508OtherMEDICAID GROUP TPI
TX180337103Medicaid
TX9419551OtherPHCS PIN
TX180337103Medicaid
TX8L21344Medicare PIN