Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Keith Aniel Russworm Jr., NP

Individual provider Nurse Practitioner · NPI 1497263222

Keith Aniel Russworm Jr., NP is a Nurse Practitioner in Pine Bluff, Arkansas. Qualified in 2017, 9 years ago. Practices with Southeast Arkansas Emergency Physicians LLP, an 18-clinician group and accepts Medicare assignment. Licensed in Arkansas.

Years since qualifying
9
Licensed in
AR
In the registry since
2018
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

1600 W 40th Ave
Pine Bluff, AR 71603-6301
Phone: (870) 541-7100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence A005484 (AR)

Record details

NPI number1497263222
Entity typeIndividual (Type 1)
GenderMale
Credentials NP
Sole proprietorNo
NPI enumeratedJanuary 15, 2018
Last updated in NPPESJanuary 25, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Southeast Arkansas Emergency Physicians Llp — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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