Provider Demographics
NPI:1235198805
Name:BREWER, KATIE E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:E
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 1:5920 100TH ST SW
Mailing Address - Street 2:STE 26
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2751
Mailing Address - Country:US
Mailing Address - Phone:253-588-0756
Mailing Address - Fax:253-581-3787
Practice Address - Street 1:17336 PICKWICK DR
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6179
Practice Address - Country:US
Practice Address - Phone:540-338-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004413363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110004413OtherVA LICENSE
CO26102846Medicaid
VAMB3040603OtherDEA #
COCO40470Medicare PIN