MEDICARE: AMANDA FORTNER MITCHELL PA-C

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	363AS0400X	Surgical Physician Assistant	PA1328	AL
2	363A00000X	Physician Assistant	PA1328	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629576483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA FORTNER MITCHELL PA-C

Provider Business Mailing Address
First Line	:	1303 GAULT AVE N STE IV
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3104
Country	:	US
Telephone Number	:	256-273-5320
Fax Number	:	256-273-5320

Provider Business Practice Location Address
First Line	:	1303 GAULT AVE N STE IV
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3104
Country	:	US
Telephone Number	:	256-273-5320
Fax Number	:	256-273-5320

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

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/29/2026

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