Healthcare Provider Details

I. General information

NPI: 1225970478
Provider Name (Legal Business Name): DONALD RUFFIN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KREBS AVE STE C
PASCAGOULA MS
39567-3123
US

IV. Provider business mailing address

40 BEY LEA RD STE C101
TOMS RIVER NJ
08753-2900
US

V. Phone/Fax

Practice location:
  • Phone: 228-549-1019
  • Fax:
Mailing address:
  • Phone: 732-831-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1238062
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908278
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: