Provider Demographics
NPI:1326038027
Name:PEASE, DONNA JENELL (ANP/GNP,BC-ADM,CDE)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JENELL
Last Name:PEASE
Suffix:
Gender:F
Credentials:ANP/GNP,BC-ADM,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 LAKE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2877
Mailing Address - Country:US
Mailing Address - Phone:931-801-9166
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8328
Practice Address - Fax:270-798-8112
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN336363LA2200X
HIAPRN 336363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health