Provider Demographics
NPI:1104916113
Name:EWER, KEITH S (CRNA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:S
Last Name:EWER
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 1:474 SOUTHWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8917
Mailing Address - Country:US
Mailing Address - Phone:501-843-5858
Mailing Address - Fax:
Practice Address - Street 1:474 SOUTHWOOD CIR
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-8917
Practice Address - Country:US
Practice Address - Phone:501-843-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00270367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121464701Medicaid
AR121464701Medicaid