Individual
STEPHANIE MACHELLE DOUGLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
5600 GOODMAN RD, STE B, OLIVE BRANCH, MS 38654-7002
(662) 890-7010
(662) 890-7044
Mailing address
5600 GOODMAN RD STE B, OLIVE BRANCH, MS 38654-7002
(662) 890-7010
(662) 890-2704
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R863198
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08121826
—
MS
Enumeration date
05/17/2012
Last updated
06/23/2025
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