Healthcare Provider Details

I. General information

NPI: 1780406892
Provider Name (Legal Business Name): ELAINE MCKINESS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5956 NW 91ST CT
JOHNSTON IA
50131-1891
US

IV. Provider business mailing address

5956 NW 91ST CT
JOHNSTON IA
50131-1891
US

V. Phone/Fax

Practice location:
  • Phone: 515-824-5415
  • Fax: 515-436-5508
Mailing address:
  • Phone: 515-824-5415
  • Fax: 515-436-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG182199
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: