Organization
PURPLE MAGNOLIA HEALTHCARE LLC
Active
Other names
Purple Magnolia Healthcare LLP.
Organization subpart
No
Provider details
NPI number
Authorized official
CHANCELYN PENN (OWNER AND PRACTITIONER)
(601) 419-7665
Entity
Organization
Contact information
Practice address
1520 29TH AVE STE 3, GULFPORT, MS 39501-2843
(601) 419-7665
Mailing address
1520 29TH AVE STE 3, GULFPORT, MS 39501-2843
(601) 419-7665
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/21/2024
Last updated
06/18/2024
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