Provider Demographics
NPI:1801368618
Name:MITCHELL, TRACIE MICHELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:MICHELLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:T.
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:T MITCHELL,MSN CRNP
Mailing Address - Street 1:1004 SOUTH ST E
Mailing Address - Street 2:STE A
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2621
Mailing Address - Country:US
Mailing Address - Phone:256-362-2013
Mailing Address - Fax:256-362-2015
Practice Address - Street 1:1004 SOUTH ST E
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2621
Practice Address - Country:US
Practice Address - Phone:256-493-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-072535163WG0000X, 261QR1300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health