Provider Demographics
NPI:1659451748
Name:MCQUEEN, KIMBERLY HELEN (HS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HELEN
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 KEMPTON PARK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2553
Mailing Address - Country:US
Mailing Address - Phone:757-628-4368
Mailing Address - Fax:757-628-4355
Practice Address - Street 1:3000 KEMPTON PARK RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2553
Practice Address - Country:US
Practice Address - Phone:757-628-4368
Practice Address - Fax:757-628-4355
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman