Provider Demographics
NPI:1760773055
Name:BREWER, SHELLEY LADD (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LADD
Last Name:BREWER
Suffix:
Gender:F
Credentials:FNP
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 219
Mailing Address - Street 2:1950 DUPONT ROAD
Mailing Address - City:NEW JOHNSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37134-0219
Mailing Address - Country:US
Mailing Address - Phone:931-535-7216
Mailing Address - Fax:931-535-7699
Practice Address - Street 1:1950 DUPONT ROAD
Practice Address - Street 2:BUILDING 525, MEDICAL DEPARTMENT
Practice Address - City:NEW JOHNSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37134
Practice Address - Country:US
Practice Address - Phone:931-535-7216
Practice Address - Fax:931-535-7699
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily