Basic Information
| Provider Information | |||||||||
| NPI: | 1851659593 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWBY | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHUNK | ||||||||
| OtherFirstName: | KATHRYN | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4848 E CACTUS RD | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852544163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029960190 | ||||||||
| FaxNumber: | 6029965516 | ||||||||
| Practice Location | |||||||||
| Address1: | 4848 E CACTUS RD | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852544163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029960190 | ||||||||
| FaxNumber: | 6029965516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2012 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | R-9477 | IA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 006874 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.