Provider Demographics
NPI:1568545556
Name:MCDONALD, ANGELA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NBHC MERIDIAN 1801 FULLER RD BLDG 367
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39309-3107
Mailing Address - Country:US
Mailing Address - Phone:601-679-2210
Mailing Address - Fax:
Practice Address - Street 1:NBHC MERIDIAN 1801 FULLER ST BLDG 367
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39309-3107
Practice Address - Country:US
Practice Address - Phone:601-679-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS828992363L00000X
MSR828992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122452Medicaid
TX8EZ84HMedicare PIN
TX8EZ82HMedicare PIN
MS00122452Medicaid
TX8EZ85HMedicare PIN
TX8EZ83HMedicare PIN