Healthcare Provider Details

I. General information

NPI: 1780668954
Provider Name (Legal Business Name): MARY ELLEN MITCHELL MSN,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELLEN ROWSEY MSN, FNP

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 GARFIELD ST SUITE 201
TUPELO MS
38801-6301
US

IV. Provider business mailing address

PO BOX 21 DIGESTIVE HEALTH SPECIALISTS, PA
TUPELO MS
38802-0021
US

V. Phone/Fax

Practice location:
  • Phone: 662-680-5565
  • Fax: 662-840-8636
Mailing address:
  • Phone: 662-680-5565
  • Fax: 662-840-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR863519
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: