MEDICARE: ELAINE MCKINESS PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G182199	IA

General Provider Information

NPI Number	:	1780406892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE MCKINESS PMHNP-BC

Provider Business Mailing Address
First Line	:	5956 NW 91ST CT
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-1891
Country	:	US
Telephone Number	:	515-824-5415
Fax Number	:	515-436-5508

Provider Business Practice Location Address
First Line	:	5956 NW 91ST CT
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-1891
Country	:	US
Telephone Number	:	515-824-5415
Fax Number	:	515-436-5508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	06/09/2026

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