Provider Demographics
NPI:1235738857
Name:MITCHELL, TEMPESTT MONIQUE
Entity Type:Individual
Prefix:
First Name:TEMPESTT
Middle Name:MONIQUE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4016
Mailing Address - Country:US
Mailing Address - Phone:225-828-5520
Mailing Address - Fax:
Practice Address - Street 1:4720 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4016
Practice Address - Country:US
Practice Address - Phone:225-828-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health