Individual
KEONTE A FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
825 FAIRFAX AVE, SUITE 201, NORFOLK, VA 23507-1914
(757) 446-7040
(757) 446-7049
Mailing address
PO BOX 936, EVMS MEDICAL GROUP, NORFOLK, VA 23501-0936
(757) 446-7040
(757) 446-7049
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024170695
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-022
TRICARE/CHAMPUS
VA
01
—
10111665N
OPTIMA HEALTH
VA
01
—
1881039675
VIRGINIA PREMIER HEALTH PLAN
VA
05
—
1881039675
—
NC
05
—
1881039675
—
VA
01
—
PAR
CORVEL
VA
Enumeration date
05/07/2013
Last updated
02/28/2014
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