Healthcare Provider Details

I. General information

NPI: 1356707509
Provider Name (Legal Business Name): ASHLEY MITCHELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 W ANTHEM WAY SUITE C-116
ANTHEM AZ
85086-0440
US

IV. Provider business mailing address

39506 N DAISY MOUNTAIN DR #122-147
PHOENIX AZ
85086-1663
US

V. Phone/Fax

Practice location:
  • Phone: 623-434-5748
  • Fax: 623-551-8822
Mailing address:
  • Phone: 623-687-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8374
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: