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Individual

KELLY G MCQUEEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
2204 PAVILION DR, SUITE 310, KINGSPORT, TN 37660-4657
(423) 224-3900
(423) 224-3901
Mailing address
276 FIELDSTONE DR, JONESVILLE, VA 24263-1215
(423) 224-3900
(423) 224-3901

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102203973
VA
207Q00000X
Family Medicine Physician
Primary
1209
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1306807979
VA
05
1509015
TN
01
P00878625
RAILROAD MEDICARE
TN
Enumeration date
03/31/2006
Last updated
08/02/2021
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