Healthcare Provider Details

I. General information

NPI: 1184129876
Provider Name (Legal Business Name): ALLISON NICOLE BREWER APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N LEVISA RD
MOUTHCARD KY
41548-8117
US

IV. Provider business mailing address

19777 GRAPEVINE RD
PHYLLIS KY
41554-8819
US

V. Phone/Fax

Practice location:
  • Phone: 606-835-2305
  • Fax:
Mailing address:
  • Phone: 606-434-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3012212
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: