Individual provider Active NPI

Jeannie Ann McKinnon, PHARMD

  • Pharmacist
  • Jacksonville, FL
National Provider Identifier
1447551031
Registry record updated Nov 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS31303 Issued in FL
Practice address
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone
(904) 953-7917
NPI assigned
Nov 12, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2010

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS31303 FL Primary
Pharmacist 183500000X PH1839 HI
Pharmacist 183500000X 3028 NH
Pharmacist 183500000X 9301 SC
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X RPH 19015 GA

Addresses

Primary practice location

4500 San Pablo Rd S
Jacksonville, FL 32224-1865

Mailing address

PO Box 1943
Fernandina Beach, FL 32035-1943
Phone (904) 654-4964

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
PS31303FLMDPharmacist
PH1839HIMDPharmacist
RPH 19015GAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

NPI Registry JSON

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

{
    "created_epoch": "1289520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289520000000",
    "number": "1447551031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1943",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320351943",
            "telephone_number": "904-654-4964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-7917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "JEANNIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-12",
        "last_updated": "2010-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS31303",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "HI",
            "license": "PH1839",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NH",
            "license": "3028",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "9301",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "GA",
            "license": "RPH 19015",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.