Provider Demographics
NPI:1083493837
Name:BREW-SMITH, AGATHA VERONICA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AGATHA
Middle Name:VERONICA
Last Name:BREW-SMITH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 HANOVER LN
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-7091
Mailing Address - Country:US
Mailing Address - Phone:718-598-3906
Mailing Address - Fax:
Practice Address - Street 1:1409 HANOVER LN
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-7091
Practice Address - Country:US
Practice Address - Phone:718-598-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133287363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health