Healthcare Provider Details

I. General information

NPI: 1235561960
Provider Name (Legal Business Name): STEVEN KEITH OWENS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 09/27/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 SOUTHCREST PKWY
SOUTHAVEN MS
38671-4739
US

IV. Provider business mailing address

PO BOX 235022
MONTGOMERY AL
36123-5022
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-2659
  • Fax: 662-349-2653
Mailing address:
  • Phone: 334-386-2053
  • Fax: 334-244-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR870773
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number20812
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: