Healthcare Provider Details

I. General information

NPI: 1942255245
Provider Name (Legal Business Name): KEITH ALLEN EVERITT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 KNOX PLZ
BARBOURVILLE KY
40906-7300
US

IV. Provider business mailing address

325 FLOYD BRANCH RD
BEREA KY
40403-8666
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-7777
  • Fax: 606-545-7611
Mailing address:
  • Phone: 859-986-6036
  • Fax: 859-986-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3002444
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3002444
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: