Provider Demographics
NPI:1053662007
Name:MCDONALD, KERBY B (APMHNP-BC)
Entity type:Individual
Prefix:
First Name:KERBY
Middle Name:B
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:APMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 W FAIRVIEW ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4712
Mailing Address - Country:US
Mailing Address - Phone:480-800-4890
Mailing Address - Fax:480-427-4766
Practice Address - Street 1:2201 W FAIRVIEW ST STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4712
Practice Address - Country:US
Practice Address - Phone:480-800-4890
Practice Address - Fax:480-427-4766
Is Sole Proprietor?:No
Enumeration Date:2012-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860526363LP0808X
AZAP96782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health