Provider Demographics
NPI:1205690468
Name:MITCHELL, KRYSTAL (FNP)
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 MIDDEN DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6611
Mailing Address - Country:US
Mailing Address - Phone:504-419-4232
Mailing Address - Fax:
Practice Address - Street 1:4300 PATRIOT ST
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4305
Practice Address - Country:US
Practice Address - Phone:504-371-1318
Practice Address - Fax:504-371-1328
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234462207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine