Provider Demographics
NPI:1114357027
Name:BREWER, KARIN KAY (MSN, APRN, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:KAY
Last Name:BREWER
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-1954
Mailing Address - Country:US
Mailing Address - Phone:817-884-3229
Mailing Address - Fax:
Practice Address - Street 1:1319 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4431
Practice Address - Country:US
Practice Address - Phone:817-569-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723109363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
331835402OtherMEDICAID CSHCN NUMBER
TX331835401Medicaid
8206NJOtherBLUE CROSS BLUE SHIELD
341974YRK5OtherMEDICARE