Healthcare Provider Details

I. General information

NPI: 1508656927
Provider Name (Legal Business Name): RACHEL GRETE DONOVAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTHLAKE AVE
RIDGELAND MS
39157-1715
US

IV. Provider business mailing address

143 BAILEYS RIDGE CIR
CLINTON MS
39056-6225
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-4696
  • Fax:
Mailing address:
  • Phone: 601-832-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number907433
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: