Healthcare Provider Details

I. General information

NPI: 1609772995
Provider Name (Legal Business Name): BREWER MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2026
Last Update Date: 10/15/2026
Certification Date: 10/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13478 BOHRER LN
RAYVILLE MO
64084-8266
US

IV. Provider business mailing address

13478 BOHRER LN
RAYVILLE MO
64084-8266
US

V. Phone/Fax

Practice location:
  • Phone: 870-740-7292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAYLA BREWER-CLEMENTS
Title or Position: OWNER
Credential: APRN, FNP-C
Phone: 870-740-7292