1780668954 NPI number — MARY ELLEN MITCHELL MSN,FNP

Table of content: MARY ELLEN MITCHELL MSN,FNP (NPI 1780668954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780668954 NPI number — MARY ELLEN MITCHELL MSN,FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
MARY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN,FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROWSEY
Provider Other First Name:
MARY
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780668954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21
Provider Second Line Business Mailing Address:
DIGESTIVE HEALTH SPECIALISTS, PA
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38802-0021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-680-5565
Provider Business Mailing Address Fax Number:
662-840-8636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
589 GARFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38801-6301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-680-5565
Provider Business Practice Location Address Fax Number:
662-840-8636
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R863519 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0126313 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0355656-22 . This is a "ANCC CERTIFICATION FNP" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: R863519 . This is a "RN LICENSE NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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