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General NPI Number Information
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NPI Number | 1366380248
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MENTAL HEALTH AND WELLNESS PLLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 549 E PASS RD
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City | GULFPORT
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State | MS
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Zip | 39507-3261
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Country | US
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Telephone | 228-338-6853
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Fax | 228-333-0682
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Provider Business Mailing Address
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Address Line | 1110 COWAN RD STE B #202
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City | GULFPORT
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State | MS
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Zip | 39507-3441
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Country | US
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Telephone | 228-338-6853
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Fax | 228-333-0682
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Authorized Official
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Title or Position | OWNER
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Name | CHARLOTTE AEGER ROSS
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Credential | PMHNP
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Telephone | 228-338-6853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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