MEDICARE: SHELIA RENEE MITCHELL P.A.

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	363AM0700X	Medical Physician Assistant	PA1266	TN
2	363AM0700X	Medical Physician Assistant	2401	CO
3	363A00000X	Physician Assistant	1266	TN

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	:	1689669996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELIA RENEE MITCHELL P.A.

Provider Business Mailing Address
First Line	:	650 JOEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-798-8388
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 JOEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-412-0422
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	06/18/2025

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