MEDICARE: MARSHA KAY MITCHELL C.N.P.

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	RN251463	OH
2	363LF0000X	Family Nurse Practitioner	COA.10799-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659502904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA KAY MITCHELL C.N.P.

Provider Business Mailing Address
First Line	:	6437 MCCOPPIN MILL RD
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-8791
Country	:	US
Telephone Number	:	740-649-7498
Fax Number	:

Provider Business Practice Location Address
First Line	:	11130 NORTH SHORE DR.
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-8977
Country	:	US
Telephone Number	:	937-393-6121
Fax Number	:	937-393-6121

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

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	11/02/2018

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