Provider Demographics
NPI:1639258270
Name:MITCHELL, BARBARA A (CRNA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1490 CORTNER RD
Mailing Address - Street 2:
Mailing Address - City:WARTRACE
Mailing Address - State:TN
Mailing Address - Zip Code:37183-3402
Mailing Address - Country:US
Mailing Address - Phone:615-406-9544
Mailing Address - Fax:
Practice Address - Street 1:LAKE CUMBERLAND REGIONAL HOSPTIAL
Practice Address - Street 2:305 LANGDON ST
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-679-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10998367500000X
AL1-074663367500000X
OH019956367500000X
COC-APN.0000930367500000X
KY3006891367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3626309Medicaid
TN3626309Medicaid