Provider Demographics
NPI:1710244108
Name:MITCHELL, ANGELIA MADGE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:MADGE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:MADGE
Other - Last Name:ROOKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:AL
Mailing Address - Zip Code:35048-0389
Mailing Address - Country:US
Mailing Address - Phone:205-625-3561
Mailing Address - Fax:205-274-9638
Practice Address - Street 1:101 LEMLEY DR
Practice Address - Street 2:SUITE A
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2100
Practice Address - Country:US
Practice Address - Phone:205-625-3561
Practice Address - Fax:205-274-9638
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-112680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily