Provider Demographics
NPI:1336780527
Name:PAUL, MARY ELIZABETH (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:PAUL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-0558
Mailing Address - Country:US
Mailing Address - Phone:601-469-4151
Mailing Address - Fax:
Practice Address - Street 1:1129 HIGHWAY 35 S STE 1
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-8829
Practice Address - Country:US
Practice Address - Phone:601-469-3320
Practice Address - Fax:601-469-3323
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903484363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health