Provider Demographics
NPI:1275194045
Name:MITCHELL, KADEAN ALICIA
Entity Type:Individual
Prefix:
First Name:KADEAN
Middle Name:ALICIA
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 1:40 S MAIN ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5513
Mailing Address - Country:US
Mailing Address - Phone:866-949-0108
Mailing Address - Fax:
Practice Address - Street 1:40 S MAIN ST STE 1300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-5513
Practice Address - Country:US
Practice Address - Phone:866-949-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309065-1363LA2200X
NY309065363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health