Provider Demographics
NPI:1275277162
Name:MITCHELL, ABBY RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:RENEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:RENEE
Other - Last Name:LIBBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:955 N 400W
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9727
Mailing Address - Country:US
Mailing Address - Phone:812-661-2021
Mailing Address - Fax:
Practice Address - Street 1:955 N 400W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9727
Practice Address - Country:US
Practice Address - Phone:812-661-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IN10003696A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant