Provider Demographics
NPI:1184865164
Name:MCDONALD, STEVEN LEE (APRN)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LEE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-3420
Mailing Address - Country:US
Mailing Address - Phone:479-675-2455
Mailing Address - Fax:479-675-4940
Practice Address - Street 1:880 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-3420
Practice Address - Country:US
Practice Address - Phone:479-675-2455
Practice Address - Fax:479-675-4940
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03209 ANP363LF0000X
ARA003209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily