Provider Demographics
NPI:1982647251
Name:MITCHELL, CAROLYN LEE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 W WOODCHASE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1647
Mailing Address - Country:US
Mailing Address - Phone:865-207-2193
Mailing Address - Fax:865-966-6062
Practice Address - Street 1:4428 SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5008
Practice Address - Country:US
Practice Address - Phone:865-588-6425
Practice Address - Fax:865-671-2879
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10996363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0091462Medicaid
TNQ39728Medicare UPIN
TN3648975Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER