Laura E. McKinzie, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209-010209 Issued in IL

Practice address

6812 State Route 162
Suite 21
Maryville, IL 62062-8553

Phone

(618) 288-7855

Fax

(618) 288-7866

NPI assigned

Feb 26, 2013

Last updated

Jun 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Laura E Bragee Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Musick Dermatology and Advanced Clinical Spa LLCGroup PAC ID 3577636604, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lmckinzie@directaddress.net
• FHIR API: https://fhir-myrecord.cerner.com/r4/GRzkF6yCy_Pe-6F3SJzcXkCEiy_u6zZe/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Musick Dermatology & Advanced Clinical Spa, LLC

  • Dermatology Physician
  • Swansea, IL
  • NPI 1922260587
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1361836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1922348002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4955 S STATE ROUTE 159",
            "address_2": "UNIT 1",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341907",
            "telephone_number": "618-288-7855",
            "fax_number": "618-288-7866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6812 STATE ROUTE 162",
            "address_2": "SUITE 21",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628553",
            "telephone_number": "618-288-7855",
            "fax_number": "618-288-7866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINZIE",
        "first_name": "LAURA",
        "middle_name": "E.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-26",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-010209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "BRAGEE",
            "middle_name": "E",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maryville Physicians Services Inc
• Maryville Radiology Group, LTD
• Maryville Womens Center SSR PC
• Kara L McGarrahan, OT
• Robert C. McKee, MD
• Katrina McNair-Smith, MS,CCC-A
• Anna McNamara, PT, DPT
• McPherson Medical & Diagnostic LLC (American Medical Missouri)
• Med Plus Physical Medicine LLC
• Holly Mellenthin

• Nurse Practitioner in Maryville, IL
• Providers in Maryville, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; 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.