Healthcare Provider Details

I. General information

NPI: 1134089766
Provider Name (Legal Business Name): DONNA LOUISE WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 COWART ST STE 1
LUCEDALE MS
39452-6032
US

IV. Provider business mailing address

91680 HIGHWAY 42
RICHTON MS
39476-9758
US

V. Phone/Fax

Practice location:
  • Phone: 601-530-5317
  • Fax: 601-429-9105
Mailing address:
  • Phone: 601-788-4165
  • Fax: 601-788-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number907919
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: