Provider Demographics
NPI:1023420809
Name:MCDONALD, PAUL (CRNP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BRAY LN
Mailing Address - Street 2:
Mailing Address - City:BEECH BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:38313-1822
Mailing Address - Country:US
Mailing Address - Phone:731-616-5175
Mailing Address - Fax:
Practice Address - Street 1:104 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2212
Practice Address - Country:US
Practice Address - Phone:731-616-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9296521363LA2100X
AL1-114040363LA2100X
TN30017363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care