Healthcare Provider Details

I. General information

NPI: 1982908877
Provider Name (Legal Business Name): PETAL URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 EVELYN GANDY PKWY STE 60
PETAL MS
39465-3953
US

IV. Provider business mailing address

PO BOX 1248
OCEAN SPRINGS MS
39566-1248
US

V. Phone/Fax

Practice location:
  • Phone: 707-319-5068
  • Fax: 601-602-4681
Mailing address:
  • Phone: 601-336-5393
  • Fax: 601-602-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIANNE NICHOLE WHITNEY
Title or Position: COO/PRESIDENT
Credential:
Phone: 707-319-5068