Provider Demographics
NPI:1295165868
Name:BREWER, JANA LYNN
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:LYNN
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:LYNN
Other - Last Name:BROCIOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 WHITTINGTON PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4928
Mailing Address - Country:US
Mailing Address - Phone:502-625-5584
Mailing Address - Fax:502-426-2264
Practice Address - Street 1:320 WHITTINGTON PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4928
Practice Address - Country:US
Practice Address - Phone:502-625-5584
Practice Address - Fax:502-426-2264
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1117893163W00000X
KY3008463367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse