Provider Demographics
NPI:1700952264
Name:MCDONALD, ALICE C (FNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:C
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 1:1125 SCHILLING BLVD E
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7078
Mailing Address - Country:US
Mailing Address - Phone:901-853-2021
Mailing Address - Fax:901-853-2434
Practice Address - Street 1:1125 SCHILLING BLVD E
Practice Address - Street 2:SUITE 105
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-7078
Practice Address - Country:US
Practice Address - Phone:901-853-2021
Practice Address - Fax:901-853-2434
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN55997OtherTN LICENSE
TN5679OtherAPRN
TN5679OtherAPRN