MEDICARE: JESI V MITCHELL NP

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	363LA2200X	Adult Health Nurse Practitioner	1006382	TX
2	363LA2100X	Acute Care Nurse Practitioner	1006382	TX
3	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	1006382	TX

General Provider Information

NPI Number	:	1639784101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESI V MITCHELL NP

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 QUITMAN ST STE B
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1032
Country	:	US
Telephone Number	:	903-708-7179
Fax Number	:	903-708-7183

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

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	12/19/2023

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