Provider Demographics
NPI:1326686486
Name:BREWER, KENDRA DANIELLE
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:DANIELLE
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 1:3508 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3914
Mailing Address - Country:US
Mailing Address - Phone:214-251-5677
Mailing Address - Fax:
Practice Address - Street 1:8140 N MOPAC EXPY STE 3-210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8859
Practice Address - Country:US
Practice Address - Phone:923-751-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145187367500000X
TX845601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse