Provider Demographics
NPI:1528499886
Name:ISOM, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ISOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 MCCONNELL CIR
Mailing Address - Street 2:APT. 12
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3323
Mailing Address - Country:US
Mailing Address - Phone:870-502-9439
Mailing Address - Fax:
Practice Address - Street 1:204 FRANKIE LN
Practice Address - Street 2:204
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2699
Practice Address - Country:US
Practice Address - Phone:870-247-2305
Practice Address - Fax:870-247-2330
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator