Provider Demographics
NPI:1851058804
Name:MITCHELL, JENNY LEE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LEE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11005 HEBER SPRINGS RD N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:AR
Practice Address - Zip Code:72523-9561
Practice Address - Country:US
Practice Address - Phone:844-291-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR215242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily