# SOUTHERN ROOTS PSYCHIATRY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558152066
- **Authorized official:** JENNIFER ETHEL SIZEMORE CRNP, PMHNP-BC (OWNER / PMHNP-BC)
- **Authorized official phone:** (850) 693-4171

## Contact information

- **Practice address:** 4469 CLINTON ST STE B, MARIANNA, FL 32446-3453
- **Practice address phone:** (850) 693-4171
- **Practice address fax:** (850) 303-6006
- **Mailing address:** 90 SOUTHERN OAK DR, DOTHAN, AL 36301-7643
- **Mailing address phone:** (850) 658-2569
- **Mailing address fax:** (850) 303-6006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2025
- **Last updated:** 09/09/2026