Individual
KETTY M SPAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
514 W ATLANTIC ST, SOUTH HILL, VA 23970-1906
(434) 584-2000
(434) 447-2240
Mailing address
514 W ATLANTIC ST, 82 MAPLEWOOD LANE, SOUTH HILL, VA 23970-1906
(434) 584-2000
(434) 447-2240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024167836
VA
363LF0000X
Family Nurse Practitioner
Primary
0024167836
VA
363LF0000X
Family Nurse Practitioner
5006092
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427225846
—
VA
Enumeration date
05/14/2008
Last updated
01/13/2017
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