Provider Demographics
NPI:1184602583
Name:MITCHELL, KIA MICHON (MD)
Entity type:Individual
Prefix:DR
First Name:KIA
Middle Name:MICHON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12086 FORT CAROLINE RD STE 401
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7640
Mailing Address - Country:US
Mailing Address - Phone:904-565-1271
Mailing Address - Fax:904-683-6884
Practice Address - Street 1:12086 FORT CAROLINE RD
Practice Address - Street 2:STE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2687
Practice Address - Country:US
Practice Address - Phone:904-565-1271
Practice Address - Fax:904-645-7325
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273549100Medicaid
FL29405OtherFL BLUE
FL29405OtherFL BLUE
FL29405UMedicare PIN