Provider Demographics
NPI:1609139153
Name:BREWER, JESSICA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:BREWER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 S BOSTON CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-5214
Mailing Address - Country:US
Mailing Address - Phone:580-277-5551
Mailing Address - Fax:
Practice Address - Street 1:2907 S BOSTON CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-5214
Practice Address - Country:US
Practice Address - Phone:580-277-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89364363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner