Provider Demographics
NPI:1053483644
Name:MCDONALD, DONNA JO (APN, CNM, MSN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:APN, CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MCFARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3995
Mailing Address - Country:US
Mailing Address - Phone:423-714-0714
Mailing Address - Fax:423-587-3799
Practice Address - Street 1:609 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3995
Practice Address - Country:US
Practice Address - Phone:423-714-0714
Practice Address - Fax:423-587-3799
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006347363LA2200X
NCCNM710367A00000X, 176B00000X
TNAPN0000006347367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505062Medicaid
TN103I422444Medicare PIN
TN1505062Medicaid