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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

KEITH ANIEL RUSSWORM JR., NP

Active

Nurse Practitioner · PINE BLUFF, AR

Registration Details

NPI Number
1497263222
Provider Type
Individual
Gender
Male
NPI Issued
Jan 15, 2018 (8.262893977257 yrs)
Last Updated
Jan 25, 2018
License
A005484 (AR)

Practice Information

Address
1600 W 40TH AVE
PINE BLUFF, AR, 716036301
Browse AR providers · Browse ZIP 71603
Phone
8705417100
Primary Specialty
Nurse Practitioner
363L00000X

Other Nurse Practitioner Providers in PINE BLUFF, AR

Name Credential NPI
SARAH KATHERINE BROWN ANP 1205009818
MEREDITH B ALLISON ANP 1619275070
VERNIECE BEAVERS NP 1245512185
SHAUN YOUNG NP-C 1285091140
MELISSA CAROL KOONCE APRN 1811415540
JAIME COUTURE MSN, RN, FNP-C 1184107138
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.