Healthcare Provider Details

I. General information

NPI: 1912828617
Provider Name (Legal Business Name): RICKEY LEE BREWER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 HEATH WAY APT C
INDIANAPOLIS IN
46237-2475
US

IV. Provider business mailing address

5427 HEATH WAY APT C
INDIANAPOLIS IN
46237-2475
US

V. Phone/Fax

Practice location:
  • Phone: 317-341-2627
  • Fax:
Mailing address:
  • Phone: 317-341-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28249732C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: