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General NPI Number Information
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NPI Number | 1629936703
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Entity Type | Organization
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Legal Business Name | KETAVIA
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 5309 COMMONWEALTH CENTRE PKWY STE 105
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2633
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Country | US
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Telephone | 804-940-8959
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Fax | 804-308-3362
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Provider Business Mailing Address
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Address Line | 5309 COMMONWEALTH CENTRE PKWY STE 103
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2633
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Country | US
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Telephone | 804-940-8959
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Fax | 804-308-3362
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEISHA LOPEZ
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Credential | DNP
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Telephone | 804-308-3403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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