Healthcare Provider Details

I. General information

NPI: 1386772283
Provider Name (Legal Business Name): CHERRYL D PURVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15444 DEDEAUX RD STE B
GULFPORT MS
39503-2637
US

IV. Provider business mailing address

15444 DEDEAUX RD STE B
GULFPORT MS
39503-2637
US

V. Phone/Fax

Practice location:
  • Phone: 228-832-9038
  • Fax: 228-832-9990
Mailing address:
  • Phone: 228-832-9038
  • Fax: 228-832-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR655481
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR655481
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: