Healthcare Provider Details

I. General information

NPI: 1346909272
Provider Name (Legal Business Name): JANA KAE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SE 2ND ST
PENDLETON OR
97801-2224
US

IV. Provider business mailing address

331 SE 2ND ST
PENDLETON OR
97801-2224
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-6207
  • Fax: 541-276-4628
Mailing address:
  • Phone: 541-276-6207
  • Fax: 541-255-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberQMHA-R-1646
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: