Healthcare Provider Details

I. General information

NPI: 1659785582
Provider Name (Legal Business Name): ROBIN THEO MITCHELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 SALUDA POINTE DR
LEXINGTON SC
29072-7295
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-785-3590
  • Fax: 803-785-3595
Mailing address:
  • Phone: 803-785-3590
  • Fax: 803-785-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number18793
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18793
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: