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Purple Magnolia Healthcare LLC

Company Details

Name: Purple Magnolia Healthcare LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 16 Feb 2024 (a year ago)
Business ID: 1429983
ZIP code: 39501
County: Harrison
State of Incorporation: LOUISIANA
Principal Office Address: 1520 29th ave. suite 3Gulfport, MS 39501

Agent

Name Role Address
Chancelyn Penn Agent 1520 29th Ave , STE. 3, Gulfport, MS 39501

Manager

Name Role Address
Chancelyn Penn Manager 3700 ORLEANS AVE APT 5438, New Orleans, LA 70119

National Provider Identifier

NPI Number:
1932965563
Certification Date:
2024-06-18

Authorized Person:

Name:
CHANCELYN PENN
Role:
OWNER AND PRACTITIONER
Phone:

Taxonomy:

Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LP2300X - Primary Care Nurse Practitioner
Is Primary:
Yes

Contacts:

Filings

Type Status Filed Date Description
Formation Form Filed 2024-02-16 Formation For Purple Magnolia Healthcare LLC

Date of last update: 13 Apr 2025

Sources: Mississippi Secretary of State