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 1:830 SOUTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1001
Mailing Address - Country:US
Mailing Address - Phone:757-683-2800
Mailing Address - Fax:757-683-2528
Practice Address - Street 1:830 SOUTHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1001
Practice Address - Country:US
Practice Address - Phone:757-683-2800
Practice Address - Fax:757-683-2528
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2025-01-28
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
NC1124384656Medicaid
VA1124384656Medicaid
VA-010OtherTRICARE/CHAMPUS
VA1124384656OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherCORVEL
VAPAROtherUSA MANAGED CARE
VAPAROtherMULTIPLAN
VA10127469NOtherOPTIMA HEALTH
NC1124384656Medicaid