Hailey Wilson McKinley, DDS, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

25687 Issued in FL

Practice address

10 Saint Johns Medical Park Dr Ste C
St Augustine, FL 32086-5202

Phone

(904) 794-1000

NPI assigned

May 3, 2021

Last updated

May 10, 2021By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 11, 2024 through Jun 11, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Florida Sedation, Implant and Dental Surgery Associates, LLC

  dba Dental Specialists of North Florida

  • Periodontics
  • St Augustine, FL
  • NPI 1932623733
  NPD

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1922681337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 BIRD ISLAND DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320806204",
            "telephone_number": "812-661-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SAINT JOHNS MEDICAL PARK DR STE C",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865202",
            "telephone_number": "904-794-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINLEY",
        "first_name": "HAILEY",
        "middle_name": "WILSON",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "25687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany McKay, M.S., CCC-SLP
• Sevanista D McKee, APRN
• Alicia McKenzie, M.S. CCC-SLP
• Mark Daniel McKenzie
• Thomas Edward McKenzie, D.O.
• Joseph Matthew McKinley, M.D.
• Kim McKinney, OT/PT
• McLellan Dental Inc.
• Barbara Agnes McLellan, D.D.S.
• Matthew McLellan, DMD

• Periodontics in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.