STEPHANIE MACHELLE DOUGLASS (NPI# 1386904803) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386904803 |
| Entity Type | Individual |
| Full Name | STEPHANIE MACHELLE DOUGLASS |
| Credential | PMHNP-BC |
| Practice Address |
5600 Goodman Rd Ste B Olive Branch MS 38654-7002 |
| Practice Telephone | 6628907010 |
| Practice Fax Number | 6628907044 |
| Mailing Telephone | 6628907010 |
| Mailing Fax Number | 6627725940 |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2020-09-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
R863198 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 08121826 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6880 Cobblestone Blvd Ste 2, Southaven, MS 386729313 | 6625108606 | 8443973305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891062709 | Stephanie Celine Douglass | Nurse Practitioner | 127 Oneida Valley Rd, Suite 400, Butler, PA 16001-2239 | 2011-11-20 |
| 1952611303 | Stephanie Douglass | Social Worker | 180 Livingston St, Suite 303, Brooklyn, NY 11201-5861 | 2010-10-19 |
| 1134186208 | Stephanie Douglass | Nurse Anesthetist, Certified Registered | 1514 Jefferson Hwy, New Orleans, LA 70121-2429 | 2006-05-01 |
| Street Address |
5600 GOODMAN RD STE B |
| City | OLIVE BRANCH |
| State | MS |
| Zip Code | 38654-7002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093888661 | Diane Marie Donohue | Dermatology | 5600 Goodman Rd, Suite C, Olive Branch, MS 38654-7002 | 2006-11-15 |
| 1992264360 | Breion Mason | Nurse Practitioner | 5600 Goodman Rd, Olive Branch, MS 38654-7002 | 2019-03-15 |
| 1851798961 | Specialty Care Extended Hours Clinic LLC | General Practice | 5600 Goodman Rd, Suite D, Olive Branch, MS 38654-7002 | 2014-12-04 |
| 1609183292 | Specialty Hospice,llc | Hospice Care, Community Based | 5600 Goodman Rd, Suite D, Olive Branch, MS 38654-7002 | 2010-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093366213 | Latonya Shontae Binion | Home Health | 5915 Brice Cove North, Olive Branch, MS 38654 | 2019-09-28 |
| 1356828677 | Heath Bryan Coleman, Dds of Mississippi II, Pllc | Dentist | 688 Goodman Rd, Ste 123, Olive Branch, MS 38654 | 2018-07-20 |
| 1629565684 | Alexis Summerville Mcdavis | Pharmacist | 7950 Craft Goodman Frontage Rd, Olive Branch, MS 38654 | 2018-04-16 |
| 1194237206 | Exos Physical Therapy and Sports Medicine, LLC | Physical Therapist | 6542 Goodman Rd, Olive Branch, MS 38654 | 2017-10-30 |
| 1609386515 | Laken Hood Richardson | Physical Therapist | 9085 East Sandidge Cove, Suite 250, Olive Branch, MS 38654 | 2017-10-05 |
| 1275064255 | Heart of Hospice, LLC | Hospice Care, Community Based | 9849 Highway 178 Unit B, Olive Branch, MS 38654 | 2017-03-22 |
| 1023557865 | Michael Patrick Mccallum | Counselor | 9320 Railroad Ave., Olive Branch, MS 38654 | 2017-02-13 |
| 1891179768 | Desoto Children's Clinic - Olive Branch | Pediatrics | 7145 Goodman Road, Olive Branch, MS 38654 | 2015-07-10 |
| 1891185203 | Kristina Harper | Midwife | 9086 Pigeon Roost Rd Ste C, Olive Branch, MS 38654 | 2015-01-23 |
| 1275955098 | Global Medical | Durable Medical Equipment & Medical Supplies | 6229 Hwy 305 Ste L, Olivebranch, MS 38654 | 2014-01-14 |
| Find all providers in zip 38654 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932742988 | Pure Light Psychiatry LLC | Nurse Practitioner | 5600 Goodman Rd Ste B, Olive Branch, MS 38654-7002 | 2019-10-22 |
| 1740837194 | Ginnifer Poole Hutcheson | Nurse Practitioner | 9035 E Sandidge Rd Ste 101, Olive Branch, MS 38654-3563 | 2019-08-21 |
| 1306303011 | Olive Branch Psychiatric Services | Nurse Practitioner | 6914 Autumn Oaks Dr Ste A, Olive Branch, MS 38654-9380 | 2019-02-28 |
| 1104309178 | Tomika Washington | Nurse Practitioner | 6914 Autumn Oaks Dr Ste A, Olive Branch, MS 38654-9380 | 2018-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548861909 | Sheila Ruth Cater Murphy | Nurse Practitioner | 761 Ripley Ave, 761 Ripley Ave, Ashland, MS 38603 | 2020-11-03 |
| 1376157487 | Rebekah N Stallworth | Nurse Practitioner | 5200 Griffin St, Moss Point, MS 39563-2020 | 2020-09-04 |
| 1588278006 | Shayla Lee | Nurse Practitioner | 665 S Pear Orchard Rd Ste 106-591, Ridgeland, MS 39157-4861 | 2020-09-02 |
| 1093329633 | Mary Lindsey Lumley | Nurse Practitioner | 620 Hwy 51, Brookhaven, MS 39601 | 2020-09-01 |
| 1548874159 | Susan Me'chelle Oliver | Nurse Practitioner | 874 Barnes Crossing Road, Tupelo, MS 38804 | 2020-09-01 |
| 1093325409 | Justin Robert Ragon | Nurse Practitioner | 40 Roosters Ln, Carriere, MS 39426-7022 | 2020-07-31 |
| 1467078220 | Scott Drennan | Nurse Practitioner | 2105 Sandalwood Pl, Gautier, MS 39553-7705 | 2020-06-17 |
| 1811511819 | Aretha M. Northington | Nurse Practitioner | 1430 Wingfield Dr., Jackson, MS 39204-4448 | 2020-06-04 |
| 1336770015 | Jamie Alise Mcfarland | Nurse Practitioner | 8752 Cat Tail Dr, Southaven, MS 38671-5072 | 2020-01-30 |
| 1942840996 | Cocetha Belton | Nurse Practitioner | 201 Copper Ridge Way, Florence, MS 39073-4601 | 2020-01-07 |
| Find all providers with the same taxonomy | ||||
| City | OLIVE BRANCH |
| Zip Code | 38654 |
Please comment or provide details below to improve the information on STEPHANIE MACHELLE DOUGLASS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.