Individual
KEVIN QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3110 MACCORKLE AVE SE, CHARLESTON, WV 25304-1210
(304) 388-9950
Mailing address
18 POPE WAY, SOUTH CHARLESTON, WV 25309-2221
(304) 687-2023
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
89471
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
104105
WV
Other
Enumeration date
04/15/2019
Last updated
09/04/2019
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