Individual provider Active NPI

Bethany McQueen, FNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Melbourne, FL
National Provider Identifier
1083138622
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN9321760 Issued in FL
Practice address
1335 Valentine St
Melbourne, FL 32901-3127
Phone
(321) 586-5444
NPI assigned
Jul 26, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Family Nurse Practitioner 363LF0000X 9321760 FL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN9321760 FL Primary

Addresses

Primary practice location

1335 Valentine St
Melbourne, FL 32901-3127

Mailing address

1335 Valentine St
Melbourne, FL 32901-3127
Phone (321) 586-5444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190501002796 FL Practitioner - Nurse Practitioner 2668714296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Psychiatric Walk-in CorpGroup PAC ID 7315391679, 13 clinicians

Practice addresses (Care Compare)

1335 Valentine St
Melbourne, FL 32901-3127
Phone (321) 586-5444

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9321760FLMDFamily Nurse Practitioner
APRN9321760FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Psychiatric Walk-in Corp CurrentSince Sep 21, 2023 Accepting new patients

Locations

1335 Valentine St
Melbourne, FL 32901
Phone (321) 586-5444

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1083138622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 VALENTINE ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013127",
            "telephone_number": "321-586-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 VALENTINE ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013127",
            "telephone_number": "321-586-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCQUEEN",
        "first_name": "BETHANY",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-26",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9321760",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN9321760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.