Provider Demographics
NPI:1689383705
Name:BOWER, KEETON KELLY (RN)
Entity Type:Individual
Prefix:
First Name:KEETON
Middle Name:KELLY
Last Name:BOWER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MINNESOTA CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-1127
Mailing Address - Country:US
Mailing Address - Phone:720-900-7115
Mailing Address - Fax:
Practice Address - Street 1:142 MINNESOTA CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-1127
Practice Address - Country:US
Practice Address - Phone:720-900-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty