Provider Demographics
NPI:1982913588
Name:RHODES-MCDONALD, SHIRLEY A (FNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:RHODES-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 1:6670 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3810
Mailing Address - Country:US
Mailing Address - Phone:901-384-9000
Mailing Address - Fax:
Practice Address - Street 1:6670 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3810
Practice Address - Country:US
Practice Address - Phone:901-384-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN161333163W00000X
TN15551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619915113OtherCLINIC NPI
R120353OtherGROUP PTAN
OR213342Medicaid
1619915113OtherCLINIC NPI