Healthcare Provider Details

I. General information

NPI: 1902914898
Provider Name (Legal Business Name): JOAN JENKINS MITCHELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PERDIDO ST
NEW ORLEANS LA
70112-1262
US

IV. Provider business mailing address

1231 BARONNE ST
NEW ORLEANS LA
70113-1203
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-0811
  • Fax: 504-301-6238
Mailing address:
  • Phone: 504-589-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number47485
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: