Provider Demographics
NPI:1578998951
Name:BREWER, CECELIA GARCIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:GARCIA
Last Name:BREWER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848268
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8268
Mailing Address - Country:US
Mailing Address - Phone:806-354-3627
Mailing Address - Fax:806-351-7274
Practice Address - Street 1:1411 E AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5555
Practice Address - Country:US
Practice Address - Phone:806-351-7510
Practice Address - Fax:806-351-7274
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123990363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3284226 02Medicaid
TX3284226 02Medicaid