Individual provider · Type 1 NPI

Keith Aniel Russworm Jr., NP

Nurse Practitioner · Pine Bluff, AR

NPI number 1497263222 Active

Practice location

1600 W 40th Ave
Pine Bluff, AR 71603-6301

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000XA005484 (AR)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1497263222

Keith Aniel Russworm Jr., NP's National Provider Identifier is 1497263222, issued on Jan 15, 2018. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Pine Bluff, AR. The record was last updated on Jan 25, 2018.