Provider Demographics
NPI:1609120013
Name:BREWER, JODIE (PA-C)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E 82ND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3159
Mailing Address - Country:US
Mailing Address - Phone:907-865-8455
Mailing Address - Fax:913-246-4901
Practice Address - Street 1:615 E 82ND AVE STE 204
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3159
Practice Address - Country:US
Practice Address - Phone:907-865-8455
Practice Address - Fax:913-246-4901
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK103866363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical