Provider Demographics
NPI:1073886446
Name:BREVIL, NOHEMIE (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:NOHEMIE
Middle Name:
Last Name:BREVIL
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-0060
Mailing Address - Country:US
Mailing Address - Phone:662-579-3449
Mailing Address - Fax:662-579-3469
Practice Address - Street 1:818 E SUNFLOWER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2824
Practice Address - Country:US
Practice Address - Phone:662-579-3449
Practice Address - Fax:662-579-3459
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057385208000000X
MS23162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09226861Medicaid