Provider Demographics
NPI:1164157533
Name:BREWER, BAILEY CARSON
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:CARSON
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 63RD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-1148
Mailing Address - Country:US
Mailing Address - Phone:601-462-1046
Mailing Address - Fax:
Practice Address - Street 1:1207 63RD ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-1148
Practice Address - Country:US
Practice Address - Phone:601-462-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program