Active NPI
Nicole Marie McKinnon, RN
- Registered Nurse
- Salt Lake City, UT
National Provider Identifier
1558101121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 50147
- Practice address
- 440 S 500 E
Salt Lake City, UT 84102-2705 - Phone
- (801) 359-8862
- Fax
- (801) 359-8510
- NPI assigned
- May 30, 2024
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 50147 | ID | Primary |
Addresses
Primary practice location
440 S 500 E
Salt Lake City, UT 84102-2705
Mailing address
440 S 500 E
Salt Lake City, UT 84102-2705
Phone (801) 359-8862
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
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50147 | ID | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717027200000",
"number": "1558101121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 S 500 E",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841022705",
"telephone_number": "801-359-8862",
"fax_number": "801-359-8510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 S 500 E",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841022705",
"telephone_number": "801-359-8862",
"fax_number": "801-359-8510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINNON",
"first_name": "NICOLE",
"middle_name": "MARIE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-30",
"last_updated": "2024-05-30",
"certification_date": "2024-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "ID",
"license": "50147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.