Basic Information
| Provider Information | |||||||||
| NPI: | 1184865164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 880 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BOONEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729273420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796752455 | ||||||||
| FaxNumber: | 4796754940 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BOONEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729273420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796752455 | ||||||||
| FaxNumber: | 4796754940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2009 | ||||||||
| LastUpdateDate: | 12/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A03209 ANP | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.