Provider Demographics
NPI:1134160518
Name:BREWER, LINDA (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:NP
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 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-4749
Mailing Address - Fax:601-200-5929
Practice Address - Street 1:610 SECOND ST
Practice Address - Street 2:
Practice Address - City:PELAHATCHIE
Practice Address - State:MS
Practice Address - Zip Code:39145-3135
Practice Address - Country:US
Practice Address - Phone:601-854-5044
Practice Address - Fax:601-854-8448
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR544787363LG0600X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114606Medicaid
MSR73888Medicare UPIN
MSR73888Medicare UPIN