Provider Demographics
NPI:1124384656
Name:SPENCE, KEIA T (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KEIA
Middle Name:T
Last Name:SPENCE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KEIA
Other - Middle Name:TAWAN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2760 GODWIN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8501
Mailing Address - Country:US
Mailing Address - Phone:757-983-8650
Mailing Address - Fax:757-983-8673
Practice Address - Street 1:2760 GODWIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8501
Practice Address - Country:US
Practice Address - Phone:757-983-8650
Practice Address - Fax:757-983-8673
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherCORVEL
VA1124384656Medicaid
VA10127469NOtherOPTIMA HEALTH
VA1124384656OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherUSA MANAGED CARE
VA-010OtherTRICARE/CHAMPUS
NC1124384656Medicaid
VAPAROtherMULTIPLAN
NC1124384656Medicaid