Basic Information
| Provider Information | |||||||||
| NPI: | 1639800626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREWER | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | JEANINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7210 OVERLAND PARK BLVD E | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322444258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048039197 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3901 CARMICHAEL AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322072325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048996300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2022 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | APRN11020301 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.