Provider Demographics
NPI:1235660655
Name:JAMES, KEISHA Q (FNP-C)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:Q
Last Name:JAMES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 PRUDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4229
Mailing Address - Country:US
Mailing Address - Phone:804-925-7600
Mailing Address - Fax:804-681-0051
Practice Address - Street 1:2580 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4229
Practice Address - Country:US
Practice Address - Phone:804-925-7600
Practice Address - Fax:804-681-0051
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily