Provider Demographics
NPI:1063065373
Name:HART, KEITH (NP)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:HART
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 MONUMENT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1760
Mailing Address - Country:US
Mailing Address - Phone:804-307-9561
Mailing Address - Fax:
Practice Address - Street 1:1101 E MARSHALL ST STE 1-030
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5048
Practice Address - Country:US
Practice Address - Phone:804-828-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001252679163WE0003X
VA0024177892363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency