Provider Demographics
NPI:1710197371
Name:BREWER, JEREMIAH (MHPP)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 DEQUEEN ST
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4132
Mailing Address - Country:US
Mailing Address - Phone:479-394-3200
Mailing Address - Fax:479-394-3205
Practice Address - Street 1:1210 DEQUEEN ST
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4132
Practice Address - Country:US
Practice Address - Phone:479-394-3200
Practice Address - Fax:479-394-3205
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator