Provider Demographics
NPI:1376081752
Name:MITCHELL, CHERYL D (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16284
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76162-0284
Mailing Address - Country:US
Mailing Address - Phone:817-568-8411
Mailing Address - Fax:817-568-8414
Practice Address - Street 1:11803 S. FREEWAY
Practice Address - Street 2:STE. 311
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115
Practice Address - Country:US
Practice Address - Phone:817-568-8411
Practice Address - Fax:817-568-8414
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132639363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care