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General NPI Number Information
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NPI Number | 1790279875
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Entity Type | Individual
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Provider Name | KEISHA NICOLA THIGPEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 5839 HARBOUR VIEW BLVD
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City | SUFFOLK
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State | VA
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Zip | 23435-2659
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Country | US
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Telephone | 757-483-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 3725 SHORELINE DR
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City | PORTSMOUTH
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State | VA
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Zip | 23703-4035
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | VA
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