Stephanie Machelle Douglass, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R863198 Issued in MS

Practice address

5600 Goodman Rd
Ste B
Olive Branch, MS 38654-7002

Phone

(662) 890-7010

Fax

(662) 890-7044

NPI assigned

May 17, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pure Light Psychiatry LLCGroup PAC ID 4789019365, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pure Light Psychiatry LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Olive Branch, MS
  • NPI 1932742988
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1386904803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 GOODMAN RD STE B",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547002",
            "telephone_number": "662-890-7010",
            "fax_number": "662-890-2704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 GOODMAN RD",
            "address_2": "STE B",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547002",
            "telephone_number": "662-890-7010",
            "fax_number": "662-890-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "STEPHANIE",
        "middle_name": "MACHELLE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-17",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "R863198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08121826",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Henry Desutter, D.C.
• Candace Fields Diamond, OTR/L
• Divine Breakthrough Ministries Worldwide (the Breakthrough Center)
• Kenyatta Lanette Dolison, RBT
• Diane Marie Donohue, M.D.
• Dream Team Family Dentistry, PLLC
• Drive Right, LLC (Drive Right)
• Colton Dunn, FNP-C
• Jennifer Mardis Durley, PT
• East Park Counseling Services LLC

• Psychiatric/Mental Health Nurse Practitioner in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.