Kimberly D Queen, DC, CNS, DACBN

Primary specialty

NutritionistTaxonomy code 133N00000X

License

17105 Issued in OR

Practice address

9020 SW Washington Square Rd
Ste 500
Portland, OR 97223-4491

Phone

(503) 291-7155

Fax

(503) 291-7152

NPI assigned

Jul 7, 2005

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Specialist

State licenses

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487462400000",
    "number": "1710985486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9020 SW WASHINGTON SQUARE RD",
            "address_2": "STE 500",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972234491",
            "telephone_number": "503-291-7155",
            "fax_number": "503-291-7152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9020 SW WASHINGTON SQUARE RD",
            "address_2": "STE 500",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972234491",
            "telephone_number": "503-291-7155",
            "fax_number": "503-291-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "KIMBERLY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DC, CNS, DACBN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2017-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "3106",
            "primary": false
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "OR",
            "license": "238",
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "OR",
            "license": "17105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nutritionist in Portland, OR
• Providers in Portland, OR by specialty
• Nutritionist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.