Provider Demographics
| NPI: | 1063993533 |
|---|---|
| Name: | AQUINS WELLNESS LLC |
| Entity type: | Organization |
| Organization Name: | AQUINS WELLNESS LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PSYCHIATRIC NURSE PRACTITIONER |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | QUEEN |
| Authorized Official - Middle Name: | B |
| Authorized Official - Last Name: | USI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MSN, APRN, PMHNP-BC |
| Authorized Official - Phone: | 913-602-9427 |
| Mailing Address - Street 1: | 7011 W 121ST ST STE 105 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | OVERLAND PARK |
| Mailing Address - State: | KS |
| Mailing Address - Zip Code: | 66209-2029 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 913-602-9427 |
| Mailing Address - Fax: | 913-273-0649 |
| Practice Address - Street 1: | 7011 W 121ST ST STE 105 |
| Practice Address - Street 2: | |
| Practice Address - City: | OVERLAND PARK |
| Practice Address - State: | KS |
| Practice Address - Zip Code: | 66209 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 913-601-5220 |
| Practice Address - Fax: | 913-273-0649 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2018-08-23 |
| Last Update Date: | 2018-08-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| KS | 77799 | 364SP0807X, 364SP0809X, 364SP0811X, 364SP0812X, 364SP0813X, 363LP0808X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
| No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
| No | 364SP0811X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Chronically Ill | Group - Multi-Specialty |
| No | 364SP0812X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Community | Group - Multi-Specialty |
| No | 364SP0813X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Geropsychiatric | Group - Multi-Specialty |
