Provider Demographics
NPI:1073752903
Name:MITCHELL, JENNIFER ELEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELEEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 FM 407 STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7193
Mailing Address - Country:US
Mailing Address - Phone:972-317-1110
Mailing Address - Fax:972-317-1556
Practice Address - Street 1:2012 FM 407 STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-7193
Practice Address - Country:US
Practice Address - Phone:972-317-1110
Practice Address - Fax:972-317-1556
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant