Provider Demographics
NPI:1043540354
Name:MCDONALD, JAMIE (CNM)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16777 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3254
Mailing Address - Country:US
Mailing Address - Phone:225-761-5239
Mailing Address - Fax:225-754-5063
Practice Address - Street 1:16777 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3254
Practice Address - Country:US
Practice Address - Phone:225-761-5239
Practice Address - Fax:225-754-5063
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMH-0004176B00000X
LAAP08098367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00423542Medicaid
LA2382004Medicaid
MS00423542Medicaid
LA2382004Medicaid
LA390421YH3VMedicare PIN