Edyn McKinnon

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN216659 Issued in 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

Last updated

Sep 7, 2024By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

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.

• Compassionate Behavioral Health

  • Clinical Social Worker
  • Douglas, GA
  • NPI 1629506787
  Medicare reassignment NPD
• Hospital Authority of Jeff Davis County Georgia

  dba Jeff Davis Hospital

  • Critical Access Hospital
  • Hazlehurst, GA
  • NPI 1912902263
  Medicare reassignment NPD
• Mayo Clinic Health System in Waycross, Inc.

  • Multi-Specialty Clinic/Center
  • Waycross, GA
  • NPI 1154745982
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA, Psychiatric/Mental Health

  Medicare reassignment NPD
• Gateway Behavioral Health Services

  • Mental Illness Community Based Residential Treatment Facility
  • Brunswick, GA
  • NPI 1124254321
  NPD
• Gateway Community Service Board

  • Community/Behavioral Health Agency
  • Brunswick, GA
  • NPI 1558478214
  NPD
• Hospital Authority of Jeff Davis County Georgia

  dba Family Healthcare Connections

  • Internal Medicine Physician
  • Hazlehurst, GA
  • NPI 1528874518
  NPD
• Integrated Regional Laboratories Pathology Services, LLC

  dba IRL Pathology Services

  • Anatomic Pathology & Clinical Pathology Physician
  • Atlantis, FL
  • NPI 1942526298
  NPD

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

{
    "created_epoch": "1452729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725667200000",
    "number": "1235595604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 GA HIGHWAY 64 E",
            "city": "AXSON",
            "state": "GA",
            "postal_code": "316242032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 GA HIGHWAY 64 E",
            "city": "AXSON",
            "state": "GA",
            "postal_code": "316242032",
            "telephone_number": "912-592-3152",
            "fax_number": "628-246-8299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "408 Shirley Ave",
            "address_purpose": "LOCATION",
            "city": "Douglas",
            "state": "GA",
            "postal_code": "315332002",
            "country_code": "US",
            "telephone_number": "912-592-3152",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 ocilla rd",
            "address_purpose": "LOCATION",
            "city": "douglas",
            "state": "GA",
            "postal_code": "31533",
            "country_code": "US",
            "telephone_number": "912-384-1900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "EDYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-14",
        "last_updated": "2024-09-07",
        "certification_date": "2024-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN216659",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11021035",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN216659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "6282468299",
            "affiliation": "N",
            "endpointDescription": "Doximity Fax",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3950 Ga Highway 64 E",
            "city": "Axson",
            "state": "GA",
            "country_code": "US",
            "postal_code": "316242032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carey Ladson
• Madelyn A Tanner, APRN

• Psychiatric/Mental Health Nurse Practitioner in Axson, GA
• Providers in Axson, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.