Provider Demographics
NPI:1558075838
Name:MITCHELL, AMANDA LYNN (APN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 ROUTE 206
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-1425
Mailing Address - Country:US
Mailing Address - Phone:760-583-0350
Mailing Address - Fax:
Practice Address - Street 1:100 ASHURST LN STE 309
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1202
Practice Address - Country:US
Practice Address - Phone:856-200-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01421800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health