MEDICARE: TIERRA TENAY MITCHELL

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1912716655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERRA TENAY MITCHELL

Provider Business Mailing Address
First Line	:	3929 WEET PINE ST
Second Line	:	UNIT 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89108
Country	:	US
Telephone Number	:	661-247-7897
Fax Number	:

Provider Business Practice Location Address
First Line	:	3929 SWEET PINE ST UNIT 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-8143
Country	:	US
Telephone Number	:	661-247-7897
Fax Number	:

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

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	01/07/2025

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Directions to “ TIERRA TENAY MITCHELL ” Practice Location

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