Provider Demographics
NPI:1609898972
Name:WINDHAM, KEITH J (CRNA)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:WINDHAM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-1108
Mailing Address - Country:US
Mailing Address - Phone:256-737-2000
Mailing Address - Fax:256-737-2849
Practice Address - Street 1:1912 AL HIGHWAY 157
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-737-2882
Practice Address - Fax:256-737-2849
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-065616367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533380OtherBCBS #
ALC816Medicare PIN
Q66709Medicare UPIN