Provider Demographics
NPI:1083769772
Name:EWERS, KEESHA (ARNP)
Entity Type:Individual
Prefix:
First Name:KEESHA
Middle Name:
Last Name:EWERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25546 SE 159TH ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8249
Mailing Address - Country:US
Mailing Address - Phone:425-391-3376
Mailing Address - Fax:
Practice Address - Street 1:710 5TH AVE NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2823
Practice Address - Country:US
Practice Address - Phone:425-391-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ24358Medicare UPIN
WA8807245Medicare ID - Type Unspecified