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General NPI Number Information
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NPI Number | 1376927590
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Entity Type | Individual
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Provider Name | DANIEL KEITH SPENCER AGPCNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 5140 HATCHER RD
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City | DUBLIN
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State | VA
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Zip | 24084-4802
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Country | US
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Telephone | 540-674-5260
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Fax | 276-783-2879
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Provider Business Mailing Address
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Address Line | 121 PINEY VIEW LN
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City | MOUTH OF WILSON
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State | VA
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Zip | 24363-3694
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Country | US
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Telephone | 276-768-9058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024172749
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024172749
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License Number State | VA
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