Healthcare Provider Details

I. General information

NPI: 1932564838
Provider Name (Legal Business Name): KINGS & QUEENS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 DEVONSHIRE SQ SUITE 7
JACKSON TN
38305-2255
US

IV. Provider business mailing address

124 CHESTER LEVEE RD
JACKSON TN
38301-7562
US

V. Phone/Fax

Practice location:
  • Phone: 731-343-8684
  • Fax:
Mailing address:
  • Phone: 731-343-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number212116
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number83001
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number17750
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number17750
License Number StateTN

VIII. Authorized Official

Name: MRS. SHAMEEKA KELLY
Title or Position: DON
Credential: RN
Phone: 731-343-8684