Provider Demographics
NPI:1154313054
Name:MITCHELL, JENNIFER T (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2757
Practice Address - Fax:806-743-2563
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6508207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146288903Medicaid
NMA569OtherTRIWEST
TX146288902Medicaid
TX87418ZOtherHMO BLUE
OK200016590AMedicaid
TX8F3612OtherBCBS
TX101608100OtherFIRSTCARE COMMERCIAL
NM29557887Medicaid
TX101608101Medicaid
TX146288903Medicaid
TX146288902Medicaid
NMA569OtherTRIWEST