Healthcare Provider Details

I. General information

NPI: 1982398772
Provider Name (Legal Business Name): MR. CADEN ASHER MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 DORMITORY ROW WEST
OXFORD MS
38677
US

IV. Provider business mailing address

129 MCGRAPH CV
SALTILLO MS
38866-6880
US

V. Phone/Fax

Practice location:
  • Phone: 662-915-7211
  • Fax:
Mailing address:
  • Phone: 502-330-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1171
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: