Healthcare Provider Details

I. General information

NPI: 1295168383
Provider Name (Legal Business Name): MITCHELL SMITH MCMANIS MSN, APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 STERLING RUN BLVD
MOUNT ORAB OH
45154-8350
US

IV. Provider business mailing address

330 SEVEN SPRINGS WAY
BRENTWOOD TN
37027-5098
US

V. Phone/Fax

Practice location:
  • Phone: 937-444-6910
  • Fax:
Mailing address:
  • Phone: 606-759-9921
  • Fax: 606-759-9831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.391636
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3011192
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.19178-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: