Provider Demographics
NPI:1407910227
Name:MITCHELL, KAREN CRAIN (NP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:CRAIN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5777
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5777
Mailing Address - Country:US
Mailing Address - Phone:865-246-2104
Mailing Address - Fax:865-246-2106
Practice Address - Street 1:252 CHEROKEE PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5153
Practice Address - Country:US
Practice Address - Phone:865-980-5200
Practice Address - Fax:865-246-2106
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO175935363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09177361Medicaid
TNP40498Medicare UPIN
CO289556YL63Medicare PIN