MEDICARE: ANGELA R MITCHELL FNP

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	363LF0000X	Family Nurse Practitioner	5004210	NC
2	363LF0000X	Family Nurse Practitioner	3819P	KY
3	363LF0000X	Family Nurse Practitioner	3003819	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	11386486	OTHER	CAQH ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588634745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA R MITCHELL FNP

Provider Business Mailing Address
First Line	:	509 MEMORIAL DR STE 2
Second Line	:
City	:	MANCHESTER
State	:	KY
Zip	:	40962-6196
Country	:	US
Telephone Number	:	606-598-5104
Fax Number	:	606-598-0983

Provider Business Practice Location Address
First Line	:	509 MEMORIAL DR STE 2
Second Line	:
City	:	MANCHESTER
State	:	KY
Zip	:	40962-6196
Country	:	US
Telephone Number	:	606-598-4538
Fax Number	:	606-599-2528

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	03/07/2023

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