Provider Demographics
NPI:1164448981
Name:MITCHELL, VALARIE ALDER (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:VALARIE
Middle Name:ALDER
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7714 POPLAR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3941
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-922-6722
Practice Address - Street 1:2001 STATE DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9324
Practice Address - Country:US
Practice Address - Phone:662-286-3694
Practice Address - Fax:662-286-3853
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR855711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06275325Medicaid
TNQ064875Medicaid
MSP37209Medicare UPIN