Provider Demographics
NPI:1740896646
Name:BREWER, KELLY ANNE (RRT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:BREWER
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N STATE ROUTE 89
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313-5001
Mailing Address - Country:US
Mailing Address - Phone:928-776-6047
Mailing Address - Fax:
Practice Address - Street 1:500 N. STATE ROUTE 89
Practice Address - Street 2:CPAP CLINIC
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-776-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ004041227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered