Healthcare Provider Details

I. General information

NPI: 1811538598
Provider Name (Legal Business Name): JENNIFER LYNN MITCHELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNN BENDAS

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 HOSPITAL RD
COAL TOWNSHIP PA
17866-9668
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-644-2614
  • Fax: 570-644-2618
Mailing address:
  • Phone: 570-644-2614
  • Fax: 570-644-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061212
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA005872
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: