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General NPI Number Information
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NPI Number | 1750909008
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Entity Type | Individual
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Provider Name | SHAWN JEFFERY MITCHELL APRN
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Gender | Male
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 3250 GATEWAY BLVD STE 112
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City | PRESCOTT
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State | AZ
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Zip | 86303-6856
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Country | US
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Telephone | 928-350-7900
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Fax | 928-356-3002
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Provider Business Mailing Address
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Address Line | 1003 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1641
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Country | US
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Telephone | 928-771-5487
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 244057
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 244057
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 244057
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 244057
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License Number State | AZ
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