Provider Demographics
NPI:1619955812
Name:MITCHELL, JOHN RICHARD (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 VALIANT DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6040
Mailing Address - Country:US
Mailing Address - Phone:801-733-5256
Mailing Address - Fax:
Practice Address - Street 1:5965 SOUTH 900 EAST
Practice Address - Street 2:STE 240 VALLEY MENTAL HEALTH AD
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1720
Practice Address - Country:US
Practice Address - Phone:801-263-7225
Practice Address - Fax:801-263-7279
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT202824-3102163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107032301101OtherINTERMOUTAIN HEALTH CARE