Jacquelyn Denise McKinney, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY003852 Issued in GA

Practice address

4755 Silver Stream Dr
Cumming, GA 30040-9044

Phone

(404) 723-6408

NPI assigned

Nov 12, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacquelyn Denise Hardy Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2006

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Fresh Start for the Mind, LLCGroup PAC ID 2466681283, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Fresh Start for the Mind, LLC

  • Psychologist
  • Alpharetta, GA
  • NPI 1184966061
  Medicare reassignment Care Compare group NPD
• Focus Forward Counseling and Consulting, Inc

  • Professional Counselor
  • Cumming, GA
  • NPI 1912138710
  Medicare reassignment NPD
• 100 Percent Nutrition LLC

  • Health Service Clinic/Center
  • Gainesville, GA
  • NPI 1851909857
  NPD (past)

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

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1437555877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 SILVER STREAM DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300409044",
            "telephone_number": "404-723-6408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 SILVER STREAM DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300409044",
            "telephone_number": "404-723-6408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNEY",
        "first_name": "JACQUELYN",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-12",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "HARDY",
            "middle_name": "DENISE",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mikaela McHugh, D.C.
• Sara Marie McHugh, DO
• Chase Edward McIntosh, MD
• Elizabeth Jane McIntyre
• Christina McKellar, DMD
• Kylie Christine McKnight
• Barbara Sharp McLear, FNP
• Kimberly McLeod
• Michael Shawn McMoran
• Joseph P McNamara, D.C

• Clinical Psychologist in Cumming, GA
• Providers in Cumming, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; 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.