Healthcare Provider Details

I. General information

NPI: 1598328684
Provider Name (Legal Business Name): CAROLINE DOUGLASS PEEPLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RIVER OAKS DR STE 310
FLOWOOD MS
39232-9512
US

IV. Provider business mailing address

263 WHIPPOORWILL LN
RIDGELAND MS
39157-9467
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-5006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number903979
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number903668
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: