Provider Demographics
NPI:1306511225
Name:DOUGLAS, SHEKELA (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:SHEKELA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 CALHOUN STATION PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-5541
Mailing Address - Country:US
Mailing Address - Phone:601-540-5900
Mailing Address - Fax:
Practice Address - Street 1:105 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8496
Practice Address - Country:US
Practice Address - Phone:601-540-5900
Practice Address - Fax:228-263-3904
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904237363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health