Provider Demographics
NPI:1376927590
Name:SPENCER, DANIEL KEITH (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KEITH
Last Name:SPENCER
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PINEY VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MOUTH OF WILSON
Mailing Address - State:VA
Mailing Address - Zip Code:24363-3694
Mailing Address - Country:US
Mailing Address - Phone:276-768-9058
Mailing Address - Fax:
Practice Address - Street 1:5140 HATCHER RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-4802
Practice Address - Country:US
Practice Address - Phone:540-674-5260
Practice Address - Fax:276-783-2879
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172749363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health