Provider Demographics
NPI:1316906308
Name:BREWER, JOYCE (CFNP, CNM)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:CFNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-898-9811
Mailing Address - Fax:
Practice Address - Street 1:1207 N WEST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2018
Practice Address - Country:US
Practice Address - Phone:601-354-6654
Practice Address - Fax:601-354-6289
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR557072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116424Medicaid
MS500000272Medicare PIN
MS00116424Medicaid