Amy R Douglas, DNP, FNP-BC, WHNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

857450 Issued in MS

Practice address

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Phone

(601) 288-4329

NPI assigned

Dec 15, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Amy Campbell Former name

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, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amy.douglas.1@19538.direct.athenahealth.com
• Direct secure messaging: adouglas148062@directpatientrecord.com

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.

• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559

  Family, MS

  Medicare reassignment NPD
• Hattiesburg Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Hattiesburg, MS
  • NPI 1164805156

  MS

  Medicare reassignment NPD
• Maxem Health Urgent Care Magee

  • Urgent Care Clinic/Center
  • Magee, MS
  • NPI 1235669136

  MS

  Medicare reassignment NPD
• Ocean Springs Urgent Care

  • Urgent Care Clinic/Center
  • Ocean Springs, MS
  • NPI 1871808022

  MS

  Medicare reassignment NPD
• Orange Grove Urgent Care

  • Urgent Care Clinic/Center
  • Gulfport, MS
  • NPI 1831330661

  MS

  Medicare reassignment NPD
• Hattiesburg Clinic PA

  • Multi-Specialty Clinic/Center
  • Hattiesburg, MS
  • NPI 1740213446

  MS

  Medicare reassignment
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD
• Gulfport 49 Imaging, LLC

  • Radiology Clinic/Center
  • Gulfport, MS
  • NPI 1134702301
  NPD
• Hattiesburg Clinic, PA

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Laurel, MS
  • NPI 1245263540
  NPD (past)
• Lucedale OB/GYN Center

  • Rural Health Clinic/Center
  • Lucedale, MS
  • NPI 1518071570
  NPD (past)
• Lucedale OBGYN Center

  • Obstetrics & Gynecology Physician
  • Lucedale, MS
  • NPI 1093023491
  NPD (past)
• Trustcare Primary Care, LLC

  • Family Medicine Physician
  • Madison, MS
  • NPI 1174078554
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Forrest County General Hospital

  • General Acute Care Hospital
  • Hattiesburg, MS
  • NPI 1225041809

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1801199666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-579-5400",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-288-4329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 Jefferson St",
            "address_2": "Laurel",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MS",
            "postal_code": "394404243",
            "country_code": "US",
            "telephone_number": "601-425-2273",
            "fax_number": "601-426-9637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "AMY",
        "middle_name": "R",
        "credential": "DNP, FNP-BC, WHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-15",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MS",
            "license": "R857450",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "857450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00127100",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "CAMPBELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Goff Dixon, LCSW
• Stephen Todd Dixon, DMD
• DJ Shuttle & Tour Service, Inc.
• William Duncan Donald III, M.D.
• Courtney Nicole Dossett
• Christopher John Douglas, M.D.
• Garrett Douglas
• Laurie Evans Douglas, MD
• Sean Philip Douglas, MD
• Abigail Douglass

• All providers in Hattiesburg, MS
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.