Purple Magnolia Healthcare LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

PURPLE MAGNOLIA HEALTHCARE LLC

Practice address

1520 29TH Ave Ste 3
Gulfport, MS 39501-2843

Phone

(601) 419-7665

NPI assigned

Feb 21, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chancelyn PennNPI 1487169678

Title

Owner and Practitioner

Phone

(601) 419-7665

Specialties & licenses 3

Addresses

Other names 1

• Purple Magnolia Healthcare LLP. Former legal business name

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chancelyn S Penn, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Gulfport, MS
  • NPI 1487169678

  Single Specialty

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1932965563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 29TH AVE STE 3",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012843",
            "telephone_number": "601-419-7665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 29TH AVE STE 3",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012843",
            "telephone_number": "601-419-7665"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4835 Werner Dr",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701264445",
            "country_code": "US",
            "telephone_number": "601-419-7665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PURPLE MAGNOLIA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-21",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "PENN",
        "authorized_official_first_name": "CHANCELYN",
        "authorized_official_title_or_position": "OWNER AND PRACTITIONER",
        "authorized_official_telephone_number": "601-419-7665"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Purple Magnolia Healthcare LLP.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Purple Magnolia Healthcare LLP.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Sally M Proffitt, FNP-C
• Prosthetic Solutions Inc.
• Laura Puffer, M.ED, LPC, NCC
• Robert Pullens, RN
• Ansh Purohit, M.D
• Cherryl D Purvis, NP
• Susan Elizabeth Pyles, LCSW, BCD
• Virginia Lorain Quandt, ANP, FNP, DNP
• Clarence R Quave, DPT
• Fauzia F. Quddus, M.D.

• Primary Care Nurse Practitioner in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Primary Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.