Healthcare Provider Details

I. General information

NPI: 1134056617
Provider Name (Legal Business Name): KATHARINE DOUGLAS GUEST PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KATHARINE ELIZABETH DOUGLAS

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BAKER BLVD
LELAND MS
38756-3401
US

IV. Provider business mailing address

201 BAKER BLVD
LELAND MS
38756-3401
US

V. Phone/Fax

Practice location:
  • Phone: 662-686-4121
  • Fax:
Mailing address:
  • Phone: 662-686-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908393
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: