Basic Information
| Provider Information | |||||||||
| NPI: | 1700952264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 SCHILLING BLVD E | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | COLLIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380177078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018532021 | ||||||||
| FaxNumber: | 9018532434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 SCHILLING BLVD E | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | COLLIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380177078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018532021 | ||||||||
| FaxNumber: | 9018532434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363LF0000X | 55997 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 55997 | 01 | TN | TN LICENSE | OTHER | MM1155173 | 01 | DEA | OTHER | 5679 | 01 | TN | APRN | OTHER |