Healthcare Provider Details

I. General information

NPI: 1922486398
Provider Name (Legal Business Name): MISTY DUGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY STRICKLIN

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 250
JACKSON MS
39216-4620
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-5550
  • Fax:
Mailing address:
  • Phone: 601-200-5955
  • Fax: 601-200-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR877754
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: