Provider Demographics
NPI:1316239940
Name:BREWER, MISTY (MHPP)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 TOWNSEND LN
Mailing Address - Street 2:
Mailing Address - City:WIDEMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72585-8875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 MYERS ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7344
Practice Address - Country:US
Practice Address - Phone:870-793-8925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator