Provider Demographics
NPI:1144008657
Name:MCDONALD, HENON LEE JR (RN)
Entity type:Individual
Prefix:MR
First Name:HENON
Middle Name:LEE
Last Name:MCDONALD
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 DEVONSHIRE CV N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8580
Mailing Address - Country:US
Mailing Address - Phone:901-292-3047
Mailing Address - Fax:
Practice Address - Street 1:3316 DEVONSHIRE CV N
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8580
Practice Address - Country:US
Practice Address - Phone:901-292-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS911457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse