MEDICARE: KELLY BROOKE MITCHELL ASSOCIATE DEGREE INT

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	171R00000X	Interpreter

General Provider Information

NPI Number	:	1841314622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BROOKE MITCHELL ASSOCIATE DEGREE INT

Provider Business Mailing Address
First Line	:	PO BOX 9054
Second Line	:
City	:	GRAY
State	:	TN
Zip	:	37615-9054
Country	:	US
Telephone Number	:	423-467-3600
Fax Number	:	423-467-3644

Provider Business Practice Location Address
First Line	:	2243 EDDIE WILLIAMS RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601
Country	:	US
Telephone Number	:	423-434-0447
Fax Number	:	423-434-0880

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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