Provider Demographics
NPI:1548821333
Name:DOUGLAS, SUMNER B (NP)
Entity type:Individual
Prefix:
First Name:SUMNER
Middle Name:B
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-226-1613
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:401 BAPTIST DR STE 1040
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2009
Practice Address - Country:US
Practice Address - Phone:601-605-2383
Practice Address - Fax:601-605-3898
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2020-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS903149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily