Healthcare Provider Details

I. General information

NPI: 1740124056
Provider Name (Legal Business Name): KEYANNAH GLOVER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 AYERS MEADOW LN
SPRINGFIELD VA
22150-4915
US

IV. Provider business mailing address

2011 TAYLOR RD
SHELBY NC
28152-7947
US

V. Phone/Fax

Practice location:
  • Phone: 301-664-2880
  • Fax:
Mailing address:
  • Phone: 704-692-4604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024348
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: