Provider Demographics
NPI:1619961836
Name:KEITH, KIMBERLY DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAVIS
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1976
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-1976
Mailing Address - Country:US
Mailing Address - Phone:252-449-5500
Mailing Address - Fax:252-449-5501
Practice Address - Street 1:2808 S CROATAN HWY
Practice Address - Street 2:STE C-1
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9024
Practice Address - Country:US
Practice Address - Phone:252-449-5500
Practice Address - Fax:252-449-5501
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601644207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891004QMedicaid
NC2249298BMedicare ID - Type Unspecified
NC891004QMedicaid