Healthcare Provider Details

I. General information

NPI: 1003710971
Provider Name (Legal Business Name): CROWNED WITH PURPOSE MENTAL HEALTH WELLNESS SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 DELEWARE AVE SUITE 18
MCCOMB MS
39648
US

IV. Provider business mailing address

612 DELEWARE AVE SUITE 18
MCCOMB MS
39648
US

V. Phone/Fax

Practice location:
  • Phone: 601-803-1147
  • Fax:
Mailing address:
  • Phone: 601-803-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: KANISHA M MCKNIGHT
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 601-814-0757