Provider Demographics
NPI:1538702907
Name:KEY VITALITY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:KEY VITALITY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:KEYSHA
Authorized Official - Middle Name:DONTREA
Authorized Official - Last Name:REID-WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:844-327-3747
Mailing Address - Street 1:1130 CLOVER VALLEY WAY STE B
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2186
Mailing Address - Country:US
Mailing Address - Phone:443-506-3959
Mailing Address - Fax:
Practice Address - Street 1:7718 BELAIR RD STE 200
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4062
Practice Address - Country:US
Practice Address - Phone:844-327-3747
Practice Address - Fax:844-327-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty