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NPI Code Detail

MEDICARE: JOHN RICHARD MITCHELL RN

MEDICARE: JOHN RICHARD MITCHELL RN
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
1163WP0809XAdult Psychiatric/Mental Health Registered Nurse202824-3102UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107032301101OTHERUTINTERMOUTAIN HEALTH CARE

General Provider Information

NPI Number : 1619955812
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN RICHARD MITCHELL RN
Provider Business Mailing Address
First Line : 8316 VALIANT DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-6040
Country : US
Telephone Number : 801-733-5256
Fax Number :
Provider Business Practice Location Address
First Line : 5965 SOUTH 900 EAST
Second Line : STE 240 VALLEY MENTAL HEALTH AD
City : SALT LAKE CITY
State : UT
Zip : 84121-1720
Country : US
Telephone Number : 801-263-7225
Fax Number : 801-263-7279
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 03/17/2008

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