Provider Demographics
NPI:1952055741
Name:MITCHELL, CARRIE GULLETT (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:GULLETT
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 GRAYSTONE PL SE STE A
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8263
Mailing Address - Country:US
Mailing Address - Phone:828-326-2145
Mailing Address - Fax:
Practice Address - Street 1:3412 GRAYSTONE PL SE STE A
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8263
Practice Address - Country:US
Practice Address - Phone:828-326-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015768363L00000X, 363LF0000X
NCMITCH-LVCHW363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner