Individual
KRISTEN NICOLE BREWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
300 KATHY DRIVE, RUSSELLVILLE, AR 72802
(501) 253-2804
Mailing address
300 KATHY DRIVE, RUSSELLVILLE, AR 72802
(501) 253-2804
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4404
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237780721
—
AR
Enumeration date
01/13/2020
Last updated
03/22/2023
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