Provider Demographics
NPI:1013390764
Name:MCQUEEN, EMILY B (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:B
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SOUTH SHADY STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683
Mailing Address - Country:US
Mailing Address - Phone:423-727-1103
Mailing Address - Fax:423-727-1140
Practice Address - Street 1:1901 SOUTH SHADY STREET
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683
Practice Address - Country:US
Practice Address - Phone:423-727-1103
Practice Address - Fax:423-727-1140
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20380363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013390764Medicaid
TNQ021209Medicaid
TN1035005I39Medicare PIN