Healthcare Provider Details

I. General information

NPI: 1306551395
Provider Name (Legal Business Name): MARSHA MITCHELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DR
CORINTH MS
38834-9321
US

IV. Provider business mailing address

611 ALCORN DR
CORINTH MS
38834-9388
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1000
  • Fax:
Mailing address:
  • Phone: 662-293-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33550
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905756
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: