Provider Demographics
NPI:1275217879
Name:JONES MITCHELL, AMANDA (OWNER)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:JONES MITCHELL
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 HIGHWAY 16 EAST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051
Mailing Address - Country:US
Mailing Address - Phone:662-303-1584
Mailing Address - Fax:
Practice Address - Street 1:2342 HIGHWAY 16 EAST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051
Practice Address - Country:US
Practice Address - Phone:662-303-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS171400000X, 251E00000X, 332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No171400000XOther Service ProvidersHealth & Wellness Coach
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies