Provider Demographics
NPI:1205849502
Name:MITCHELL, ELIZABETH KAY (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KAY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:K
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1421 W BADDOUR PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2513
Mailing Address - Country:US
Mailing Address - Phone:615-449-6780
Mailing Address - Fax:615-449-1929
Practice Address - Street 1:1421 W BADDOUR PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2513
Practice Address - Country:US
Practice Address - Phone:615-449-6780
Practice Address - Fax:615-449-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3046487Medicaid
TN3046487Medicaid
TNC61013Medicare UPIN