Healthcare Provider Details

I. General information

NPI: 1942234232
Provider Name (Legal Business Name): JEFFREY JEROME MITCHELL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BAY AVE
RICHTON MS
39476-2941
US

IV. Provider business mailing address

229 ORAL CHURCH RD
SUMRALL MS
39482-4015
US

V. Phone/Fax

Practice location:
  • Phone: 601-788-6316
  • Fax: 601-788-6316
Mailing address:
  • Phone: 601-264-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR832748
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: