Provider Demographics
NPI:1083757967
Name:BREWER, KARI A (PA-C)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:A
Last Name:BREWER
Suffix:
Gender:F
Credentials:PA-C
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 996
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0996
Mailing Address - Country:US
Mailing Address - Phone:208-664-4026
Mailing Address - Fax:208-664-4840
Practice Address - Street 1:3911 CASTLEVALE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7807
Practice Address - Country:US
Practice Address - Phone:509-454-9499
Practice Address - Fax:509-457-4994
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8325789Medicaid
WAAB13449Medicare ID - Type Unspecified
WA8325789Medicaid