PURE LIGHT PSYCHIATRY LLC
NPI 1932742988
Nurse Practitioner - Psychiatric/Mental Health in Olive Branch, MS

Q: What is Pure Light Psychiatry LLC's NPI number?

The NPI number for Pure Light Psychiatry LLC is 1932742988. It was assigned to this organization in the NPPES registry on October 22, 2019.

Q: What is Pure Light Psychiatry LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Active since October 22, 2019CLIA 25D2179208 · Waiver

5600 GOODMAN RD STE B, OLIVE BRANCH, MS 38654(662) 890-7010(662) 890-7044 Get Directions Write a Review

NPPES record last updated: June 23, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 23, 2025, Jan 2, 2020, Oct 22, 2019 (3 updates tracked since 2019).

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About Pure Light Psychiatry Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PURE LIGHT PSYCHIATRY LLC (NPI 1932742988) is a healthcare organization registered as a psychiatric/mental health in Olive Branch, Mississippi and active in the NPI registry since October 2019. The organization holds a CLIA Waiver certificate valid through February 17, 2028 and lists Stephanie Machelle Douglass, Pmhnp, as its authorized official.

NPPES Registry Identity

NPI1932742988

Entity TypeOrganization

Primary Taxonomy363LP0808X

Legal Business NamePURE LIGHT PSYCHIATRY LLC

Location Address5600 GOODMAN RD STE BOlive Branch, MS 38654-7002

Mailing Address5600 Goodman Rd Ste BOlive Branch, MS 38654-7002 · (662) 890-7010 · Fax (662) 890-7044

Phone(662) 890-7010

Fax(662) 890-7044

Organization SubpartNo

Authorized OfficialStephanie Machelle DouglassPmhnp · (662) 890-7010

Enumeration DateOctober 22, 2019

Last NPPES UpdateJune 23, 20253 updates tracked since enumeration

NPPES CertifiedJune 23, 2025

✔ NPI 1932742988 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

5600 GOODMAN RD STE B, Olive Branch, MS 38654

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2179208

Pure Light Psychiatry · Olive Branch, MS

Active · expires Feb 17, 2028

CLIA Number25D2179208

Laboratory TypePractitioner Other

Certificate Effective DateFebruary 18, 2026

Certificate Expiration DateFebruary 17, 2028

Laboratory DirectorStephanie M. Douglass

Laboratory Phone(662) 890-7010

Laboratory LocationPure Light Psychiatry5600 Goodman Rd Ste B, Olive Branch, MS 38654

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAWN DENISE BURNS CASEY LCSW

Social Worker (Clinical)

5600 GOODMAN RD STE B
OLIVE BRANCH, MS 38654

Desoto County (901) 218-8117

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pure Light Psychiatry LLC's NPI number?

The NPI number for Pure Light Psychiatry LLC is 1932742988. It was assigned to this organization in the NPPES registry on October 22, 2019.

Where is Pure Light Psychiatry LLC located?

Pure Light Psychiatry LLC is located at 5600 Goodman Rd Ste B, Olive Branch, MS 38654. The listed phone number is (662) 890-7010.

What is Pure Light Psychiatry LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Does Pure Light Psychiatry LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2179208) is associated with this NPI, valid through February 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Pure Light Psychiatry LLC accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Pure Light Psychiatry LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Pure Light Psychiatry LLC was last updated on June 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.