Healthcare Provider Details
I. General information
NPI: 1902353980
Provider Name (Legal Business Name): SOMER K MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 09/07/2016
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1830 VERSAILLES RD
LEXINGTON KY
40504-1402
US
IV. Provider business mailing address
1830 VERSAILLES RD
LEXINGTON KY
40504-1402
US
V. Phone/Fax
- Phone: 859-347-2412
- Fax: 859-346-4641
- Phone: 859-347-2412
- Fax: 859-346-4641
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LG0600X |
| Taxonomy | Gerontology Nurse Practitioner |
| License Number | 3010275 |
| License Number State | KY |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | 3010275 |
| License Number State | KY |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: