Provider Demographics
NPI:1235916909
Name:MITCHELL, AMANDA LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2206 WRIGHTSVILLE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2406
Mailing Address - Country:US
Mailing Address - Phone:910-251-5326
Mailing Address - Fax:910-632-2355
Practice Address - Street 1:2206 WRIGHTSVILLE AVE STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2406
Practice Address - Country:US
Practice Address - Phone:910-251-5326
Practice Address - Fax:910-632-2355
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018812363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health