Active NPI
Mary Jane McKinnie, NP
- Adult Health Nurse Practitioner
- Lake Charles, LA
National Provider Identifier
1689774259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- AP05000
- Practice address
- 905 11TH St
Lake Charles, LA 70601-6230 - Phone
- (337) 433-7117
- Fax
- (337) 433-7117
- NPI assigned
- Sep 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | AP05000 | LA | Primary |
Addresses
Primary practice location
905 11TH St
Lake Charles, LA 70601-6230
Mailing address
905 11TH St
Lake Charles, LA 70601-6230
Phone (337) 433-7117
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1409171 | Medicaid | LA |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP05000 | LA | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226534400000",
"number": "1689774259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 11TH ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706016230",
"telephone_number": "337-433-7117",
"fax_number": "337-433-7117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 11TH ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706016230",
"telephone_number": "337-433-7117",
"fax_number": "337-433-7117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINNIE",
"first_name": "MARY",
"middle_name": "JANE",
"name_prefix": "Mrs.",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-24",
"last_updated": "2008-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "LA",
"license": "AP05000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1409171",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.