MEDICARE: MRS. JENNY LEE MITCHELL NP

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	5131	CO

General Provider Information

NPI Number	:	1689697286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY LEE MITCHELL NP

Provider Business Mailing Address
First Line	:	4455 CLARK RD
Second Line	:
City	:	CRAWFORD
State	:	CO
Zip	:	81415-9173
Country	:	US
Telephone Number	:	970-812-6403
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 ELM AVENUE
Second Line	:
City	:	CRAWFORD
State	:	CO
Zip	:	81415-9173
Country	:	US
Telephone Number	:	970-921-5501
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/07/2014

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