Provider Demographics
NPI:1942255245
Name:EVERITT, KEITH ALLEN (APRN)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALLEN
Last Name:EVERITT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:325 FLOYD BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-8666
Mailing Address - Country:US
Mailing Address - Phone:859-986-6036
Mailing Address - Fax:859-986-6036
Practice Address - Street 1:14 KNOX PLZ
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7300
Practice Address - Country:US
Practice Address - Phone:606-546-7777
Practice Address - Fax:606-545-7611
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3002444363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78024445Medicaid
KYS79379Medicare UPIN
KY0967406Medicare PIN
KY78024445Medicaid