Healthcare Provider Details

I. General information

NPI: 1922635119
Provider Name (Legal Business Name): KEVIN CHESHIRE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR STE 100
ABINGDON VA
24211-7664
US

IV. Provider business mailing address

16000 JOHNSTON MEMORIAL DR STE 100
ABINGDON VA
24211-7664
US

V. Phone/Fax

Practice location:
  • Phone: 276-477-1443
  • Fax: 276-477-1441
Mailing address:
  • Phone: 423-434-6300
  • Fax: 423-434-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0102209339
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: