Provider Demographics
NPI:1033556170
Name:MCDONALD, JACKIE LYNN (RN, COHN-S, CAOHC)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:LYNN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RN, COHN-S, CAOHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11937 HWY 271
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708-3154
Mailing Address - Country:US
Mailing Address - Phone:903-877-5553
Mailing Address - Fax:
Practice Address - Street 1:11937 HWY 271
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75708-3154
Practice Address - Country:US
Practice Address - Phone:903-877-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660165163W00000X, 163WX0106X
40275246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No163W00000XNursing Service ProvidersRegistered Nurse
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX660165OtherRN
40275OtherCAOHC
8922OtherCOHN-S