MEDICARE: JONATHAN THOMAS MITCHELL FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN03585	RI
2	207P00000X	Emergency Medicine Physician	RN52465	RI

General Provider Information

NPI Number	:	1225727563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN THOMAS MITCHELL FNP-C

Provider Business Mailing Address
First Line	:	455 TOLL GATE RD
Second Line	:	PRC AND CREDENTIALING
City	:	WARWICK
State	:	RI
Zip	:	02886-2759
Country	:	US
Telephone Number	:	401-273-0641
Fax Number	:	401-273-2919

Provider Business Practice Location Address
First Line	:	455 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2770
Country	:	US
Telephone Number	:	401-737-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	12/17/2025

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