Provider Demographics
NPI:1902135189
Name:MCDONALD, CLEMMIE JO (CRNFA)
Entity Type:Individual
Prefix:
First Name:CLEMMIE
Middle Name:JO
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 FLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9019
Mailing Address - Country:US
Mailing Address - Phone:601-936-0400
Mailing Address - Fax:601-932-4845
Practice Address - Street 1:2470 FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9019
Practice Address - Country:US
Practice Address - Phone:601-936-0400
Practice Address - Fax:601-932-4845
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR819129163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant