Healthcare Provider Details

I. General information

NPI: 1619961836
Provider Name (Legal Business Name): KIMBERLY DAVIS KEITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 02/28/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 S CROATAN HWY STE C-1
NAGS HEAD NC
27959-9024
US

IV. Provider business mailing address

PO BOX 1976
NAGS HEAD NC
27959-1976
US

V. Phone/Fax

Practice location:
  • Phone: 252-449-5500
  • Fax: 252-449-5501
Mailing address:
  • Phone: 252-449-5500
  • Fax: 252-449-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9601644
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: