Healthcare Provider Details

I. General information

NPI: 1629493549
Provider Name (Legal Business Name): MITCHELL ATKINS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 N MAIN ST
DECATUR AR
72722-9732
US

IV. Provider business mailing address

346 N MAIN ST
DECATUR AR
72722-9732
US

V. Phone/Fax

Practice location:
  • Phone: 479-752-3233
  • Fax: 479-752-3235
Mailing address:
  • Phone: 479-752-3233
  • Fax: 479-752-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004041
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: