Provider Demographics
NPI:1841613908
Name:MITCHELL, JESSICA HEATH (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:HEATH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5960 FAIRVIEW RD STE 330
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3102
Mailing Address - Country:US
Mailing Address - Phone:704-495-6334
Mailing Address - Fax:919-359-6017
Practice Address - Street 1:13557 STEELECROFT PKWY STE 1200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7556
Practice Address - Country:US
Practice Address - Phone:704-489-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3918363A00000X
NC0010-04789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1841613908Medicaid