Provider Demographics
NPI:1841741402
Name:MITCHELL, KATHRYN MCMILLAN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MCMILLAN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18982
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:251-342-3949
Mailing Address - Fax:251-266-3361
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-266-3580
Practice Address - Fax:251-266-3581
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136156363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-86266OtherBCBS
AL511-88815OtherBCBS
AL102I883347OtherMEDICARE
AL194111Medicaid
AL202567Medicaid
AL214286Medicaid
AL511-88092OtherBCBS
ALP01812617OtherRR MEDCIARE
AL511-88091OtherBCBS
AL5690905OtherAETNA
AL512-06492OtherBCBS
AL6275911OtherUHC
ALZ82059OtherVIVA HEALTH
MS02251761OtherMS MEDICAID
AL214205Medicaid
AL512-06491OtherBCBS