Provider Demographics
NPI:1760917405
Name:USI, QUEEN B (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:QUEEN
Middle Name:B
Last Name:USI
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-523-0103
Mailing Address - Fax:
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:816-523-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201905080NP363LP0808X
MO2017021977363LP0808X, 363LP0808X
PARN620389163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500776764Medicaid