Provider Demographics
NPI:1760970776
Name:MITCHELL-HOWARD, KAREN SUE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:MITCHELL-HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ROCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-3318
Mailing Address - Country:US
Mailing Address - Phone:865-730-5016
Mailing Address - Fax:
Practice Address - Street 1:515 ROCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-3318
Practice Address - Country:US
Practice Address - Phone:865-730-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000023608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty