MEDICARE: JESSICA LEIGH QUEEN APRN

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
1	363LF0000X	Family Nurse Practitioner	113324	NE

General Provider Information

NPI Number	:	1629683719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEIGH QUEEN APRN

Provider Business Mailing Address
First Line	:	6818 N 102ND AVENUE CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68122-3009
Country	:	US
Telephone Number	:	402-480-2434
Fax Number	:

Provider Business Practice Location Address
First Line	:	249 OLSON DR STE 103
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-2974
Country	:	US
Telephone Number	:	402-413-9027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	06/16/2025

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