Kim Marie McKinnon, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

294366-8900 Issued in UT

Practice address

45 W Sego Lily Dr Ste 312
Sandy, UT 84070-3643

Phone

(801) 676-9452

Fax

(801) 206-9734

NPI assigned

Jul 9, 2018

Last updated

Jan 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Anderson Wellness Group LLCGroup PAC ID 9335550631, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anderson Wellness Group LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Sandy, UT
  • NPI 1245793249
  Medicare reassignment Care Compare group NPD
• Axial-Im

  • Neuromusculoskeletal Medicine & OMM Physician
  • Riverton, UT
  • NPI 1740843697

  Family

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1003302548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8197 S 5140 W",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840812705",
            "telephone_number": "801-895-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 W SEGO LILY DR STE 312",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840703643",
            "telephone_number": "801-676-9452",
            "fax_number": "801-206-9734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "KIM",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "294366-4405",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "294366-8900",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "294366-8900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick R McDermott, MD
• Kent Davis McDonald, MS
• Haley Marlene McIntosh, FNP-C
• James Steele McIntyre, M.D.
• Jina McKinney, M.S., CCC-SLP
• Ryan McKinnon
• Bridget McMillion, DPT
• Jeffrey M McNally, MD
• Mary McNeily, PT
• Emily Rebecca McWidener

• Psychiatric/Mental Health Nurse Practitioner in Sandy, UT
• Providers in Sandy, UT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.