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NPI Code Detail

MEDICARE: MRS. JACKALYN LEE MITCHELL RN, OGNP

MEDICARE: MRS. JACKALYN LEE MITCHELL RN, OGNP
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
12083P0901XPublic Health & General Preventive Medicine Physician76450NC
2363L00000XNurse Practitioner76450NC
3363LA2200XAdult Health Nurse Practitioner76450NC
4363LC1500XCommunity Health Nurse Practitioner76450NC
5363LN0000XNeonatal Nurse Practitioner76450NC
6363LW0102XWomen's Health Nurse Practitioner76450NC
7363LX0001XObstetrics & Gynecology Nurse Practitioner76450NC
8364SP1700XPerinatal Clinical Nurse Specialist76450NC

General Provider Information

NPI Number : 1801964978
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACKALYN LEE MITCHELL RN, OGNP
Provider Business Mailing Address
First Line : 612 COLLEGE ST
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-5311
Country : US
Telephone Number : 910-347-2154
Fax Number : 910-347-0728
Provider Business Practice Location Address
First Line : 612 COLLEGE ST
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-5311
Country : US
Telephone Number : 910-347-2154
Fax Number : 910-347-0728
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 09/11/2025

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