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NPI Code Detail

MEDICARE: DR. QWEEN TI'YE DNP, APRN-CNP, PMHNP

MEDICARE: DR. QWEEN TI'YE DNP, APRN-CNP, PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner124479WV

General Provider Information

NPI Number : 1508529991
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. QWEEN TI'YE DNP, APRN-CNP, PMHNP
Provider Business Mailing Address
First Line : 98 DIVING SCAUP RD
Second Line :
City : HEDGESVILLE
State : WV
Zip : 25427-7739
Country : US
Telephone Number : 304-513-3495
Fax Number :
Provider Business Practice Location Address
First Line : 400 FOXCROFT AVE STE 104
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-5302
Country : US
Telephone Number : 304-513-3495
Fax Number : 800-734-8498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2021
Last Update Date : 01/08/2026

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