Provider Demographics
NPI:1144492794
Name:BREWSTER, KELLY N (WHNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:N
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 INNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9123
Mailing Address - Country:US
Mailing Address - Phone:985-249-7022
Mailing Address - Fax:985-249-7048
Practice Address - Street 1:104 INNWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3358
Practice Address - Country:US
Practice Address - Phone:985-249-7022
Practice Address - Fax:985-249-7048
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04907363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1504203Medicaid