Healthcare Provider Details

I. General information

NPI: 1932471745
Provider Name (Legal Business Name): SCOTT BRENNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 N BUSINESS DR STE 104
FAYETTEVILLE AR
72703-5287
US

IV. Provider business mailing address

525 N GARLAND AVE
FAYETTEVILLE AR
72701-3110
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-1532
  • Fax:
Mailing address:
  • Phone: 479-575-4451
  • Fax: 866-409-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2016018187
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-13092
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: