<unavail> in Gulfport, MS - Medicare Nurse Practitioner

is a medicare enrolled primary clinic (Nurse Practitioner - Primary Care) in Gulfport, Mississippi. The current practice location for is 1520 29th Ave Ste 3, Gulfport, Mississippi. For appointments, you can reach them via phone at (601) 419-7665. The mailing address for is 1520 29th Ave Ste 3, Gulfport, Mississippi and phone number is (601) 419-7665.

is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1932965563. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (601) 419-7665.

Contact Information


	1520 29th Ave Ste 3 Gulfport MS 39501-2843
	(601) 419-7665
	Not Available

Map and Direction

Primary Care Clinic Profile

Full Name
Speciality	Nurse Practitioner
Location	1520 29th Ave Ste 3, Gulfport, Mississippi
Authorized Official Name and Position	Chancelyn Penn (OWNER AND PRACTITIONER)
Authorized Official Contact	6014197665
Accepts Medicare Insurance	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
1520 29th Ave Ste 3 Gulfport MS 39501-2843 Ph: (601) 419-7665	1520 29th Ave Ste 3 Gulfport MS 39501-2843 Ph: (601) 419-7665

NPI Details:

NPI Number	1932965563
Provider Enumeration Date	02/21/2024
Last Update Date	06/18/2024

Medicare PECOS Information:

Medicare PECOS PAC ID	3476994401
Medicare Enrollment ID	O20240808002142

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1932965563	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
261QM1300X	Clinic/center - Multi-specialty	(* (Not Available))	Secondary
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	(* (Not Available))	Secondary
363LP2300X	Nurse Practitioner - Primary Care	(* (Not Available))	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. acts as a billing entity for following providers:

Provider Name	Chancelyn S Penn
Provider Type	Practitioner - Nurse Practitioner
Provider Identifiers	NPI Number: 1487169678 PECOS PAC ID: 3779922117 Enrollment ID: I20240808002381

Reviews and Comments

Nurse Practitioner in Gulfport, MS

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- Medicare Primary Care in Gulfport, MS