Active NPI
Holly Joelle McKinley, PSYD
- Clinical Psychologist
- Shakopee, MN
National Provider Identifier
1326640327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP6616
- Practice address
- 1555 Lusitano St
Shakopee, MN 55379-5405 - Phone
- (612) 629-7109
- NPI assigned
- Nov 13, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP6616 | MN | Primary |
Addresses
Primary practice location
1555 Lusitano St
Shakopee, MN 55379-5405
Mailing address
1555 Lusitano St
Shakopee, MN 55379-5405
Phone (612) 629-7109
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
| License | State | Type | Specialty |
|---|---|---|---|
| LP6616 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628208000000",
"number": "1326640327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1555 LUSITANO ST",
"city": "SHAKOPEE",
"state": "MN",
"postal_code": "553795405",
"telephone_number": "612-629-7109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 LUSITANO ST",
"city": "SHAKOPEE",
"state": "MN",
"postal_code": "553795405",
"telephone_number": "612-629-7109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINLEY",
"first_name": "HOLLY",
"middle_name": "JOELLE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-13",
"last_updated": "2021-08-06",
"certification_date": "2021-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP6616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shakopee, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.