Healthcare Provider Details

I. General information

NPI: 1023934619
Provider Name (Legal Business Name): KAREN KAMILLAH PURNELL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 CHESTNUT DR
SOUTHAVEN MS
38671-6535
US

IV. Provider business mailing address

1260 CHESTNUT DR
SOUTHAVEN MS
38671-6535
US

V. Phone/Fax

Practice location:
  • Phone: 662-897-8973
  • Fax:
Mailing address:
  • Phone: 662-897-8973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908444
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number42096
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: