Provider Demographics
NPI:1518467836
Name:CORDELL, DONNA (MHPP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CORDELL
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 CALVIN AVERY DR
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-6501
Mailing Address - Country:US
Mailing Address - Phone:870-732-1878
Mailing Address - Fax:870-702-7111
Practice Address - Street 1:2135 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3631
Practice Address - Country:US
Practice Address - Phone:870-523-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator