MEDICARE: JACOB 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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1871246348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB MITCHELL PA-C

Provider Business Mailing Address
First Line	:	145 MAIN ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1416
Country	:	US
Telephone Number	:	570-439-5945
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 WATER ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1117
Country	:	US
Telephone Number	:	570-724-2325
Fax Number	:

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

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	10/19/2022

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Directions to “ JACOB MITCHELL PA-C” Practice Location

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