Provider Demographics
NPI:1639413339
Name:MITCHELL, JODY LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYNN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4246
Mailing Address - Country:US
Mailing Address - Phone:785-424-4864
Mailing Address - Fax:
Practice Address - Street 1:2909 SE WALNUT DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2189
Practice Address - Country:US
Practice Address - Phone:785-267-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012039131363LF0000X
KS75764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily