Healthcare Provider Details

I. General information

NPI: 1831277573
Provider Name (Legal Business Name): NIKKI JO MITCHELL FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/10/2023
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 ROSLIN RD
NEWBURGH IN
47630-8590
US

IV. Provider business mailing address

6544 RIVER RIDGE DR
NEWBURGH IN
47630-9778
US

V. Phone/Fax

Practice location:
  • Phone: 812-996-5616
  • Fax:
Mailing address:
  • Phone: 812-660-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71002315A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002315A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71002315
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: