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

Active since October 22, 2019
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: November 08, 2026.

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

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 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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pure Light Psychiatry Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Pure Light Psychiatry LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Stephanie Douglass, PMHNP-BC
Nurse Practitioner
NPI 1386904803
5600 GOODMAN RD STE B
Olive Branch, MS 38654
(662) 890-7010
✔ PECOS✔ Accepts MedicareSame address
Heather Hildebrant, PMHNP
Nurse Practitioner
NPI 1477373512
5600 GOODMAN RD
Olive Branch, MS 38654
(662) 890-7010
✔ PECOS✔ Accepts MedicareSame address
Renee Reichert, APRN MSN PMHNP BC
Nurse Practitioner
NPI 1518426162
8830 CENTRE ST STE 2
Southaven, MS 38671
(662) 536-6253
✔ PECOS5.8 mi
Charlene Sparrow, PMHNP-BC
Nurse Practitioner
NPI 1568868099
65 GERMANTOWN CT STE 207
Cordova, TN 38018
(901) 878-3332
✔ PECOS✔ Accepts Medicare13 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

Is Pure Light Psychiatry LLC enrolled in Medicare?

Yes. Pure Light Psychiatry LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pure Light Psychiatry LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Pure Light Psychiatry LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 16 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.