# PURPLE MAGNOLIA HEALTHCARE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Purple Magnolia Healthcare LLP.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932965563
- **Authorized official:** CHANCELYN PENN (OWNER AND PRACTITIONER)
- **Authorized official phone:** (601) 419-7665

## Contact information

- **Practice address:** 1520 29TH AVE STE 3, GULFPORT, MS 39501-2843
- **Practice address phone:** (601) 419-7665
- **Mailing address:** 1520 29TH AVE STE 3, GULFPORT, MS 39501-2843
- **Mailing address phone:** (601) 419-7665

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/21/2024
- **Last updated:** 06/18/2024