Provider Demographics
NPI:1861448789
Name:MURDOCK, DONNA JAYNE (APRN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JAYNE
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 RIFE MEDICAL LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-3888
Mailing Address - Fax:479-338-4453
Practice Address - Street 1:2708 RIFE MEDICAL LN
Practice Address - Street 2:SUITE 210
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-3888
Practice Address - Fax:479-338-4453
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129126363LF0000X
KS45502363LF0000X
ARA03162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425215613Medicaid
MO33251018OtherBCBS KC
KS100407660CMedicaid
AR5R041OtherAR BCBS
MO425215613Medicaid
KS100407660CMedicaid
AR5R041OtherAR BCBS
MO33251018OtherBCBS KC
KSE68C658Medicare ID - Type UnspecifiedKC, KS