Active NPI
Jacob S Queen, PRSS
- Peer Specialist
- Charleston, WV
National Provider Identifier
1689406563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 24-9103
- Practice address
- 2157 Greenbrier St
Charleston, WV 25311-9623 - Phone
- (304) 553-0051
- NPI assigned
- Aug 19, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 24-9103 | WV | Primary |
Addresses
Primary practice location
2157 Greenbrier St
Charleston, WV 25311-9623
Mailing address
2157 Greenbrier St
Charleston, WV 25311-9623
Phone (304) 553-0051
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24-9103 | WV | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1689406563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2157 GREENBRIER ST",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253119623",
"telephone_number": "304-553-0051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2157 GREENBRIER ST",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253119623",
"telephone_number": "304-553-0051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUEEN",
"first_name": "JACOB",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "PRSS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-19",
"last_updated": "2024-08-19",
"certification_date": "2024-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "WV",
"license": "24-9103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.