Healthcare Provider Details

I. General information

NPI: 1699334276
Provider Name (Legal Business Name): CATHY RICHARDS MITCHELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44280 CAMPANULA WAY
TEMECULA CA
92592-7902
US

IV. Provider business mailing address

461 WESTERN BLVD STE 122
JACKSONVILLE NC
28546-7637
US

V. Phone/Fax

Practice location:
  • Phone: 951-466-0200
  • Fax:
Mailing address:
  • Phone: 910-333-0283
  • Fax: 910-333-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011830
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: