Provider Demographics
NPI:1386989549
Name:NEWGENT, CASEY A (PA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:A
Last Name:NEWGENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:THORP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 MEMORIAL DR STE 130B
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6704
Mailing Address - Country:US
Mailing Address - Phone:618-463-7600
Mailing Address - Fax:618-463-7601
Practice Address - Street 1:4 MEMORIAL DR
Practice Address - Street 2:STE 130B
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6751
Practice Address - Country:US
Practice Address - Phone:618-463-7600
Practice Address - Fax:618-463-7601
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015001940363A00000X
IL085.004576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant