Individual provider Active NPI

Kevin Queen, RN

  • Certified Registered Nurse Anesthetist
  • Charleston, WV
National Provider Identifier
1881257962
Registry record updated Sep 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
104105 Issued in WV
Practice address
3110 Maccorkle Ave SE
Charleston, WV 25304-1210
Phone
(304) 388-9950
NPI assigned
Apr 15, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 89471 WV
Certified Registered Nurse Anesthetist 367500000X 104105 WV Primary

Addresses

Primary practice location

3110 Maccorkle Ave SE
Charleston, WV 25304-1210

Mailing address

18 Pope Way
South Charleston, WV 25309-2221
Phone (304) 687-2023

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191015001734 WV Practitioner - Certified Registered Nurse Anesthetist (Crna) 9739410234 Reassigns benefits to 2 organizations
I20241023002328 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 9739410234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Logan Regional Anesthesia Services, LLCGroup PAC ID 4183097892, 10 clinicians

Practice addresses (Care Compare)

20 Hospital Dr
Logan, WV 25601-3452
Phone (304) 553-7680

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Registered Nurse

State licenses

LicenseStateTypeSpecialty
89471WVMDCritical Care Medicine Registered Nurse
104105WVMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of West Virginia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Aug 4, 2019 Accepting new patients
Commonwealth Anesthesia, PSC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2024 Accepting new patients
Logan Regional Anesthesia Services, LLC CurrentSince Nov 25, 2022 Accepting new patients

Locations

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

1340 Hal Greer Blvd
Huntington, WV 25701
Phone (304) 399-2960

20 Hospital Dr
Logan, WV 25601
Phone (304) 792-1101

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1881257962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 POPE WAY",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253092221",
            "telephone_number": "304-687-2023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041210",
            "telephone_number": "304-388-9950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "KEVIN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-15",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "WV",
            "license": "89471",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "104105",
            "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 Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.