Healthcare Provider Details

I. General information

NPI: 1023973443
Provider Name (Legal Business Name): TAQUISHA KEELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MONTICELLO AVE STE 1802
NORFOLK VA
23510-2670
US

IV. Provider business mailing address

440 MONTICELLO AVE STE 1802
NORFOLK VA
23510-2670
US

V. Phone/Fax

Practice location:
  • Phone: 757-504-4130
  • Fax:
Mailing address:
  • Phone: 757-504-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberA62622263
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: