Provider Demographics
NPI:1922763770
Name:MITCHELL, BENJAMIN LEE (LPN)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-8078
Mailing Address - Country:US
Mailing Address - Phone:865-247-9554
Mailing Address - Fax:
Practice Address - Street 1:143 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-8078
Practice Address - Country:US
Practice Address - Phone:865-247-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84507164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse