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: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 SUNRISE BLVD
ROMNEY WV
26757-4607
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 320
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 304-822-4561
  • Fax:
Mailing address:
  • Phone: 540-536-6548
  • Fax: 540-536-0235

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: