KEITH ANIEL RUSSWORM JR. (NPI# 1497263222) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497263222 |
| Entity Type | Individual |
| Full Name | KEITH ANIEL RUSSWORM JR. |
| Credential | NP |
| Practice Address |
1600 W 40th Ave Pine Bluff AR 71603-6301 |
| Mailing Address |
200 Corporate Blvd Lafayette LA 70508-3870 |
| Practice Telephone | 8705417100 |
| Mailing Telephone | 8008939698 |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2018-01-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | A005484 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1600 W 40TH AVE |
| City | PINE BLUFF |
| State | AR |
| Zip Code | 71603-6301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033172317 | Rebekah A Crowder | Dietitian, Registered | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2006-04-08 |
| 1164044509 | Shelly R Caine | Registered Nurse | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2020-05-08 |
| 1447870415 | Lakita Davis | Nurse Practitioner | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2020-04-20 |
| 1730739715 | Robert Benjamin Noble | Physician Assistant | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2019-09-12 |
| 1932757382 | Sarah Victoria Brown | Dietitian, Registered | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2019-08-29 |
| 1669020012 | Haley Nicole Shrell | Dietitian, Registered | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2019-08-29 |
| 1467000810 | Michael Carlton Turley | Dietitian, Registered | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2019-08-29 |
| 1639727084 | Laura Elizabeth Drinkwater | Dietitian, Registered | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2019-08-29 |
| 1316501901 | April Summer Mcghee | Nurse Practitioner | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2019-04-29 |
| 1609339365 | Andy Diaz | Physical Therapy Assistant | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2019-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700445038 | Hannah Carter | Dentist | 3801 S Olive St, Pine Bluff, AR 71603 | 2019-06-11 |
| 1821544628 | Nauman Yunus Md Pa | Internal Medicine | 1600 West 40th Ave, Jefferson Regional Medical Center, Pine Bluff, AR 71603 | 2016-08-31 |
| 1407278120 | Arkansas Cancer Clinic Pa | Radiology | 7200 South Hazel Street, Pine Bluff, AR 71603 | 2014-01-15 |
| 1730515396 | Sharon Yvette Webb | Student in an Organized Health Care Education/Training Program | 2318 Kyle Street, Pine Bluff, AR 71603 | 2013-09-16 |
| 1477992733 | David Larry Byrd | Pharmacist | 5 Longmeadow, Pine Bluff, AR 71603 | 2013-06-20 |
| 1437400371 | Thomas Jordan Harper | Pharmacist | 2809 South Camden Road, Pine Bluff, AR 71603 | 2012-10-01 |
| 1992080469 | C&d Disability.inc | Early Intervention Provider Agency | 4806 W 9th Street, Pine Bluff, AR 71603 | 2011-10-17 |
| 1457645863 | Clifton G Roaf & Marvin Q Caudle | Dentist | 1310 South Linden Street, Pine Bluff, AR 71603 | 2011-06-02 |
| 1932402682 | Mary Campbell | Licensed Practical Nurse | 2302 W. 28th, Suite A, Pine Bluff, AR 71603 | 2010-12-17 |
| 1245468925 | Evan N Newbolt | Ophthalmology | 3805 West 28th Ave, Pine Bluff, AR 71603 | 2009-07-01 |
| Find all providers in zip 71603 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | 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 with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184107138 | Jaime Couture | Nurse Practitioner | 2700 S Hazel St, Pine Bluff, AR 71603-5041 | 2018-09-14 |
| 1285091140 | Shaun Young | Nurse Practitioner | 3801 W 28th Ave, Pine Bluff, AR 71603-4774 | 2016-01-24 |
| 1881204758 | Windell Johnson, P. A. | Nurse Practitioner | 1401 S State St Ste C, Pine Bluff, AR 71601-5827 | 2020-08-05 |
| 1245877224 | Windell Lamont Johnson Sr. | Nurse Practitioner | 1401 S State St Ste C, Pine Bluff, AR 71601-5827 | 2019-12-09 |
| 1770136202 | Jena Shepherd | Nurse Practitioner | 1718 W 42nd Ave, Pine Bluff, AR 71603-7008 | 2019-07-23 |
| 1780038604 | Hetal C Patel | Nurse Practitioner | 1600 W 40th Ave, Pine Bluff, AR 71603-6301 | 2016-04-18 |
| 1225472798 | Theresa M Sikole | Nurse Practitioner | 4747 Dusty Lake Dr Ste 101, Pine Bluff, AR 71603-9057 | 2013-04-26 |
| 1497006217 | Amanda Christine Lem | Nurse Practitioner | 1609 W 40th Ave Ste 402, Pine Bluff, AR 71603-6365 | 2012-09-20 |
| 1245512185 | Verniece Beavers | Nurse Practitioner | 620 S Laurel St, Pine Bluff, AR 71601-4859 | 2011-09-16 |
| 1619275070 | Meredith B Allison | Nurse Practitioner | 4010 S Mulberry St, Pine Bluff, AR 71603-7000 | 2011-03-09 |
| Find all providers in PINE BLUFF | ||||
| City | PINE BLUFF |
| Zip Code | 71603 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.