Provider Demographics
NPI:1922681337
Name:MCKINLEY, HAILEY WILSON (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:HAILEY
Middle Name:WILSON
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BIRD ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6204
Mailing Address - Country:US
Mailing Address - Phone:812-661-0931
Mailing Address - Fax:
Practice Address - Street 1:10 SAINT JOHNS MEDICAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5202
Practice Address - Country:US
Practice Address - Phone:904-794-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL256871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics