Provider Demographics
NPI:1114062379
Name:BROWER, KERI M (LPTA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:M
Last Name:BROWER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7432
Mailing Address - Country:US
Mailing Address - Phone:870-336-0238
Mailing Address - Fax:870-336-0239
Practice Address - Street 1:3005 APACHE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7432
Practice Address - Country:US
Practice Address - Phone:870-857-0049
Practice Address - Fax:870-857-3027
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1959225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150938721Medicaid