Carissa Danielle Queen

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Practice address

19 Freedom TRL
Flatwoods, WV 26621-8079

Phone

(304) 765-7277

NPI assigned

Nov 9, 2023

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 9, 2023.

{
    "created_epoch": "1699488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1962276006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 CAMBRIDGE PL",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263302812",
            "telephone_number": "304-629-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 FREEDOM TRL",
            "city": "FLATWOODS",
            "state": "WV",
            "postal_code": "266218079",
            "telephone_number": "304-765-7277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "CARISSA",
        "middle_name": "DANIELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-09",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Buckhannon
• Community Care of West Virginia, Inc.
• Kylie Metz
• Kayla Morrison
• Kelly Peitt
• Melissa Jean Sartin
• Florence June Stokley
• Donna Rose Stout
• Stacie Dawn Stout
• Avis Irene Wilson, PCA

• All providers in Flatwoods, WV
• Personal Care Attendant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; 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.