MEDICARE: AMANDA LYNN MITCHELL APN, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ01421800	NJ

General Provider Information

NPI Number	:	1558075838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LYNN MITCHELL APN, PMHNP-BC

Provider Business Mailing Address
First Line	:	1726 ROUTE 206
Second Line	:
City	:	SOUTHAMPTON
State	:	NJ
Zip	:	08088-1425
Country	:	US
Telephone Number	:	760-583-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ASHURST LN STE 309
Second Line	:
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1202
Country	:	US
Telephone Number	:	856-200-3141
Fax Number	:

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

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	04/21/2023

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