MEDICARE: SHERRY L MITCHELL PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	209010401	IL
2	363LP0200X	Pediatric Nurse Practitioner	AP6153977	WA
3	363LP0200X	Pediatric Nurse Practitioner	RN324527	GA

General Provider Information

NPI Number	:	1306281605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY L MITCHELL PNP

Provider Business Mailing Address
First Line	:	491 HOWELL MILL DR
Second Line	:
City	:	SAUTEE NACOOCHEE
State	:	GA
Zip	:	30571-2228
Country	:	US
Telephone Number	:	757-291-0246
Fax Number	:

Provider Business Practice Location Address
First Line	:	42124 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1427
Country	:	US
Telephone Number	:	985-543-0563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	07/30/2025

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