Provider Demographics
NPI:1295168383
Name:MCMANIS, MITCHELL SMITH (MSN, APRN, CNP)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:SMITH
Last Name:MCMANIS
Suffix:
Gender:M
Credentials:MSN, APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:606-759-9921
Mailing Address - Fax:606-759-9831
Practice Address - Street 1:210 STERLING RUN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8350
Practice Address - Country:US
Practice Address - Phone:937-444-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.391636163W00000X
KY3011192363L00000X
OHCOA.19178-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner