Individual provider Active NPI

Elizabeth McKinnon

  • Pediatric Registered Nurse
  • Glendale, AZ
National Provider Identifier
1033945225
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Registered NurseTaxonomy code 163WP0200X
License
1166210 Issued in KY
Practice address
4035 W Alameda Rd
Glendale, AZ 85310-3304
Phone
(623) 445-4700
NPI assigned
Sep 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered Nurse 163WP0200X 1166210 KY Primary

Addresses

Primary practice location

4035 W Alameda Rd
Glendale, AZ 85310-3304

Mailing address

20402 N 15TH Ave
Phoenix, AZ 85027-3636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1166210KYMDPediatric Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Sage Elementary CurrentSince Sep 15, 2024 Accepting new patients

Locations

4035 W Alameda Rd
Glendale, AZ 85310
Phone (623) 445-4700

20402 N 15th Ave
Phoenix, AZ 85027
Phone (623) 445-4952

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1033945225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20402 N 15TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 W ALAMEDA RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853103304",
            "telephone_number": "623-445-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "KY",
            "license": "1166210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.