Provider Demographics
NPI:1508656927
Name:DONOVAN, RACHEL GRETE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:GRETE
Last Name:DONOVAN
Suffix:
Gender:
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 1:143 BAILEYS RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6225
Mailing Address - Country:US
Mailing Address - Phone:601-832-6748
Mailing Address - Fax:
Practice Address - Street 1:201 NORTHLAKE AVE
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1715
Practice Address - Country:US
Practice Address - Phone:601-366-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907433363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health