Healthcare Provider Details

I. General information

NPI: 1033101209
Provider Name (Legal Business Name): DEBRA K MACDONALD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 N LOUISIANA ST # A737
KENNEWICK WA
99336-7171
US

IV. Provider business mailing address

1033 COUNTRY CT
RICHLAND WA
99352-9500
US

V. Phone/Fax

Practice location:
  • Phone: 509-628-1958
  • Fax: 509-628-1959
Mailing address:
  • Phone: 509-628-1363
  • Fax: 509-628-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200550106NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006509
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: