Provider Demographics
NPI:1699913830
Name:BREWER, KELLY MILLER (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MILLER
Last Name:BREWER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 FOREST LAKES DR
Mailing Address - Street 2:
Mailing Address - City:STERRETT
Mailing Address - State:AL
Mailing Address - Zip Code:35147-8136
Mailing Address - Country:US
Mailing Address - Phone:205-447-8322
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD STE 240
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2225
Practice Address - Country:US
Practice Address - Phone:205-822-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095128163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice