Healthcare Provider Details

I. General information

NPI: 1114062379
Provider Name (Legal Business Name): KERI M BROWER L.P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 APACHE DR
JONESBORO AR
72401-7432
US

IV. Provider business mailing address

3005 APACHE DR
JONESBORO AR
72401-7432
US

V. Phone/Fax

Practice location:
  • Phone: 870-857-0049
  • Fax: 870-857-3027
Mailing address:
  • Phone: 870-336-0238
  • Fax: 870-336-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1959
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: