Provider Demographics
NPI:1962013755
Name:MITCHELL, CARRIE A
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 ASHFORD RIVER
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072
Mailing Address - Country:US
Mailing Address - Phone:281-781-6961
Mailing Address - Fax:
Practice Address - Street 1:12515 ASHFORD RIV
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5662
Practice Address - Country:US
Practice Address - Phone:281-781-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25431582172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver