Healthcare Provider Details

I. General information

NPI: 1720647035
Provider Name (Legal Business Name): KIA ANESIA MITCHELL MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2657 CLOUD LN
DECATUR GA
30034-2257
US

IV. Provider business mailing address

2657 CLOUD LN
DECATUR GA
30034-2257
US

V. Phone/Fax

Practice location:
  • Phone: 404-789-0900
  • Fax:
Mailing address:
  • Phone: 404-789-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC002764
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN187184
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC005185
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberW51662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: