Healthcare Provider Details

I. General information

NPI: 1710508254
Provider Name (Legal Business Name): HOPE DOUGLAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MURRAY GUARD DR
JACKSON TN
38305-3628
US

IV. Provider business mailing address

5005 DOLLAR RD
BUENA VISTA TN
38318-3607
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-0810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN27223
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27223
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: