Provider Demographics
NPI:1124279526
Name:MCDONALD, JAMES SAMUEL IV (ARNP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SAMUEL
Last Name:MCDONALD
Suffix:IV
Gender:M
Credentials:ARNP
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Mailing Address - Street 1:6300 LA CALMA DR
Mailing Address - Street 2:STE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3843
Mailing Address - Country:US
Mailing Address - Phone:425-449-0677
Mailing Address - Fax:
Practice Address - Street 1:6300 LA CALMA DR
Practice Address - Street 2:STE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3843
Practice Address - Country:US
Practice Address - Phone:425-449-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARN00166812163W00000X
TX721122163W00000X
WAAP60032534363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse