Provider Demographics
NPI:1487179198
Name:MITCHELL, LAVERNE (PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:LAVERNE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:LAVERNE
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC, FNP-C
Mailing Address - Street 1:18111 OAKFIELD XING
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8544
Mailing Address - Country:US
Mailing Address - Phone:281-714-8381
Mailing Address - Fax:
Practice Address - Street 1:440 N BONITA AVE STE 10
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2747
Practice Address - Country:US
Practice Address - Phone:281-714-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608802163WH0200X, 163WA2000X
TXAP134923363LF0000X, 363LP0808X
AZ290036363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator