Provider Demographics
NPI:1942208277
Name:MITCHELL, J KEITH (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:KEITH
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:KEITH
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-0351
Mailing Address - Country:US
Mailing Address - Phone:870-642-8818
Mailing Address - Fax:844-284-1064
Practice Address - Street 1:155 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-3706
Practice Address - Country:US
Practice Address - Phone:870-642-8818
Practice Address - Fax:844-284-1064
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2024-01-16
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
ARC-8135207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125229001Medicaid
AR5J334OtherBLUE CROSS BLUE SHEILD
AR125229001Medicaid
AR5J334OtherBLUE CROSS BLUE SHEILD