Edyn McKinnon
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Axson, GA
NPI 1235595604 · NPPES record last updated Sep 7, 2024
Key facts
- NPI
- 1235595604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- RN216659 (GA)
- Practice address
- 3950 Ga Highway 64 E
Axson, GA 31624-2032 - Phone
- (912) 592-3152
- Fax
- (628) 246-8299
- NPI assigned
- Jan 14, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160518001067 | GA | Practitioner - Nurse Practitioner | 2163711961 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN216659 | GA | MD | Family Nurse Practitioner |
| 11021035 | FL | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrated Regional Laboratories Pathology Services, LLC | Current | Accepting new patients | |
| Grow Healthcare Group PA | Psychiatric/Mental Health | Current |
Accepting new patients |
| Gateway Community Service Board | Current | Accepting new patients | |
| Mayo Clinic Health System in Waycross, Inc. | Current |
Accepting new patients | |
| Hospital Authority of Jeff Davis County Georgia | Current |
Accepting new patients | |
| Hospital Authority of Jeff Davis County Georgia | Current |
Accepting new patients | |
| Compassionate Behavioral Health | Current |
Accepting new patients | |
| Gateway Behavioral Health Services | Current |
Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
715 Peachtree St NE
Ste 100
Atlanta, GA 30308
Phone (202) 972-4964
700 Coastal Village Dr
Brunswick, GA 31520
Phone (912) 554-8400
1101 Ocilla Rd
Douglas, GA 31533
Phone (912) 383-5641
408 Shirley Ave
Douglas, GA 31533
Phone (912) 251-2504
163 S Tallahassee St
Hazlehurst, GA 31539
Phone (912) 375-7781
1113 E Oglethorpe Hwy
Hinesville, GA 31313
Phone (912) 280-7023
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN216659 | GA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 11021035 | FL | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | RN216659 | GA | Yes |
Addresses
Primary practice location
3950 Ga Highway 64 E
Axson, GA 31624-2032
Mailing address
3950 Ga Highway 64 E
Axson, GA 31624-2032
Other practice location 1
408 Shirley Ave
Douglas, GA 31533-2002
Phone (912) 592-3152
Other practice location 2
1101 ocilla rd
douglas, GA 31533
Phone (912) 384-1900
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | 6282468299 | Health Information Exchange (HIE) |
Other providers in Axson, GA
All providers in Axson, GA · Psychiatric/Mental Health Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.