Provider Demographics
NPI:1821646290
Name:MITCHELL, KAETHE BETH
Entity Type:Individual
Prefix:
First Name:KAETHE
Middle Name:BETH
Last Name:MITCHELL
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:SUSQUEHANNA VALLEY HIGH SCHOOL
Mailing Address - Street 2:1040 CONKLIN RD
Mailing Address - City:CONKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13748
Mailing Address - Country:US
Mailing Address - Phone:607-775-9119
Mailing Address - Fax:607-775-7509
Practice Address - Street 1:SUSQUEHANNA VALLEY HIGH SCHOOL
Practice Address - Street 2:1040 CONKLIN RD
Practice Address - City:CONKLIN
Practice Address - State:NY
Practice Address - Zip Code:13748
Practice Address - Country:US
Practice Address - Phone:607-775-9119
Practice Address - Fax:607-775-7509
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY540107163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool