Individual
CHANCELYN S PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1520 29TH AVE STE 3, GULFPORT, MS 39501-2843
(601) 419-7665
Mailing address
3700 ORLEANS AVE APT 5438, NEW ORLEANS, LA 70119-4871
(601) 419-7665
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
110298
LA
363L00000X
Nurse Practitioner
906511
MS
363LF0000X
Family Nurse Practitioner
227548
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
906511
MS
363LP2300X
Primary Care Nurse Practitioner
906511
MS
Other
Enumeration date
12/10/2017
Last updated
05/20/2024
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