Provider Demographics
NPI:1568781060
Name:MITCHELL, JAMERALL (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMERALL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 TOBACCO RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-9220
Mailing Address - Country:US
Mailing Address - Phone:706-798-0405
Mailing Address - Fax:
Practice Address - Street 1:2357 TOBACCO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-9220
Practice Address - Country:US
Practice Address - Phone:706-798-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN159656 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily