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NPI Code Detail

MEDICARE: JANE E KEITH CRNA

MEDICARE: JANE E KEITH CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse209003970IL
2367500000XCertified Registered Nurse Anesthetist209003970IL
3367500000XCertified Registered Nurse AnesthetistR 0045073OK

General Provider Information

NPI Number : 1831161538
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE E KEITH CRNA
Provider Business Mailing Address
First Line : PO BOX 1553
Second Line :
City : OWASSO
State : OK
Zip : 74055-1553
Country : US
Telephone Number : 312-203-1745
Fax Number :
Provider Business Practice Location Address
First Line : 3615 SE KENTUCKY ST
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74006-2324
Country : US
Telephone Number : 918-333-2020
Fax Number : 918-333-2020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 12/02/2015

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