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General NPI Number Information
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NPI Number | 1053875724
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Entity Type | Individual
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Provider Name | CRYSTAL LYNETTE MITCHELL
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Gender | Female
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 7272 STATE ROUTE 945
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City | MELBER
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State | KY
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Zip | 42069-8768
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Country | US
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Telephone | 270-564-8710
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Fax |
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Provider Business Mailing Address
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Address Line | 7272 STATE ROUTE 945
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City | MELBER
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State | KY
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Zip | 42069-8768
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LS0200X
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Taxonomy Name | School Nurse Practitioner
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License Number | 1102605
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3013144
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License Number State | KY
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