Individual provider Active NPI

Lauryn Alexus McKenney

  • Licensed Practical Nurse
  • Detroit, MI
National Provider Identifier
1679399604
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
4703121534 Issued in MI
Practice address
674 Glynn CT
Detroit, MI 48202-1451
Phone
(313) 707-0090
NPI assigned
Nov 25, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical NurseGroup: 193400000X SINGLE SPECIALTY GROUP 164W00000X 4703121534 MI Primary

Addresses

Primary practice location

674 Glynn CT
Detroit, MI 48202-1451

Mailing address

220 W Congress St # 1024
Detroit, MI 48226-3289
Phone (313) 513-2400

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

LicenseStateTypeSpecialty
4703121534MIMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Abundant Living Staffing Agency LLC Current Accepting new patients
Healthy Living Estates Current Accepting new patients
Living Splendidly Afc Home Current Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1679399604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 W CONGRESS ST # 1024",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482263289",
            "telephone_number": "313-513-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "674 GLYNN CT",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482021451",
            "telephone_number": "313-707-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNEY",
        "first_name": "LAURYN",
        "middle_name": "ALEXUS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703121534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.

Verify at the official NPI Registry.