Healthcare Provider Details

I. General information

NPI: 1528531985
Provider Name (Legal Business Name): RYANE PLASTER DOTY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 AVIGNON DR STE C
RIDGELAND MS
39157-5160
US

IV. Provider business mailing address

379 WILLIAMS RD
FLORENCE MS
39073-7954
US

V. Phone/Fax

Practice location:
  • Phone: 601-937-4552
  • Fax: 844-374-4872
Mailing address:
  • Phone: 601-919-5807
  • Fax: 844-374-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number902854
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: