Provider Demographics
NPI:1497283253
Name:MCKINLEY, JOHN LELAND (APRN CNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LELAND
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5275
Mailing Address - Country:US
Mailing Address - Phone:952-993-6200
Mailing Address - Fax:952-993-6685
Practice Address - Street 1:3525 MONTEREY DR
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-993-6200
Practice Address - Fax:952-993-6685
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5202363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health