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General NPI Number Information
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NPI Number | 1245838267
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Entity Type | Individual
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Provider Name | MISTY SPRING QUEEN DNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 901 PLANTATION RD
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City | BLACKSBURG
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State | VA
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Zip | 24060-3880
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Country | US
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Telephone | 540-951-0352
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Fax | 540-951-7724
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Provider Business Mailing Address
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Address Line | 118 BROAD ST
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City | DUBLIN
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State | VA
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Zip | 24084-3211
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Country | US
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Telephone | 540-674-8805
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Fax | 540-674-8670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024180200
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License Number State | VA
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