Basic Information
| Provider Information | |||||||||
| NPI: | 1477034981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | PAULINE | ||||||||
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| Credential: | DNP, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5279 SPRUCE VIEW WAY | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380024875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016061847 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1385 W BRIERBROOK RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381382208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013902930 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2018 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 188710 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 24606 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.