Provider Demographics
NPI:1316188006
Name:MITCHELL, JUDITH A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4999 SKYLINE RD. S.
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306
Mailing Address - Country:US
Mailing Address - Phone:503-371-4647
Mailing Address - Fax:503-485-8405
Practice Address - Street 1:4999 SKYLINE RD. S.
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306
Practice Address - Country:US
Practice Address - Phone:503-371-4647
Practice Address - Fax:503-485-8405
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01450363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical