Organization
KETAVIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEISHA LOPEZ DNP (OWNER)
(804) 308-3403
Entity
Organization
Contact information
Practice address
5309 COMMONWEALTH CENTRE PKWY STE 105, MIDLOTHIAN, VA 23112-2633
(804) 940-8959
(804) 308-3362
Mailing address
5309 COMMONWEALTH CENTRE PKWY STE 103, MIDLOTHIAN, VA 23112-2633
(804) 940-8959
(804) 308-3362
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/15/2026
Last updated
01/19/2026
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