Debra Renee Queen, R.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.006191 Issued in IL

Practice address

400 S Lewis LN
Carbondale, IL 62901-3547

Phone

(618) 519-9200

Fax

(618) 519-9961

NPI assigned

Jan 17, 2007

Last updated

Oct 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Debra Fout Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Carterville, IL
  • NPI 1639295314

  Dietitian, Registered

  NPD
• Shawnee Health Service and Development Corp

  dba Shawnee Health Pharmacy Carbondale

  • Community/Retail Pharmacy
  • Carbondale, IL
  • NPI 1760253447
  NPD
• Shawnee Health Service and Development Corp

  dba Marion Wellness

  • Federally Qualified Health Center (FQHC)
  • Marion, IL
  • NPI 1881624161
  NPD
• Cloud Health Medical Group of California, P.C.

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1194404327
  NPD (past)
• Cloud Health Medical Group, P.a.

  • Internal Medicine Physician
  • White Plains, NY
  • NPI 1528744935
  NPD (past)
• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465

  Dietitian, Registered

  NPD (past)
• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1659423184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CALIFORNIA ST",
            "address_2": "PO BOX 577",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "62918",
            "telephone_number": "618-519-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S LEWIS LN",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013547",
            "telephone_number": "618-519-9200",
            "fax_number": "618-519-9961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16511 state highway 83",
            "address_purpose": "LOCATION",
            "city": "Poteau",
            "state": "OK",
            "postal_code": "749530487",
            "country_code": "US",
            "telephone_number": "918-721-9290",
            "fax_number": "918-658-2663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "DEBRA",
        "middle_name": "RENEE",
        "credential": "R.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AR",
            "license": "1025",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.006191",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OK",
            "license": "LD718",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "FOUT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Dana Lynn Pritchett, PTA
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• Amy Elizabeth Prudencio, LCSW
• Psychological Services and Chronic Pain Management Inc. (Psychological Services Inc.)
• Shawn Wayne Pyle, CRNA
• Gloria Queriapa-Valdes, BAS, CD (DONA)
• Radiologic Interpretations of Southern Illinois LTD
• Michael Rafati, MD
• Rainbow Cafe Lgbtq Center
• Srinivas Rajamahanty, M.D.

• Registered Dietitian in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.