Healthcare Provider Details

I. General information

NPI: 1124384656
Provider Name (Legal Business Name): KEIA T SPENCE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEIA TAWAN ROBINSON

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SOUTHAMPTON AVE
NORFOLK VA
23510-1001
US

IV. Provider business mailing address

830 SOUTHAMPTON AVE
NORFOLK VA
23510-1001
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-2800
  • Fax: 757-683-2528
Mailing address:
  • Phone: 757-683-2800
  • Fax: 757-683-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: