Provider Demographics
NPI:1578137956
Name:BREWER, KYLIE (NP)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 MOSS MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3907
Mailing Address - Country:US
Mailing Address - Phone:408-832-5700
Mailing Address - Fax:
Practice Address - Street 1:1600 COIT RD STE 202
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6171
Practice Address - Country:US
Practice Address - Phone:972-596-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104005218363LW0102X
GARN289822363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty