Provider Demographics
NPI:1669754214
Name:MITCHELL, AUNDRE R (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:AUNDRE
Middle Name:R
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1843
Mailing Address - Country:US
Mailing Address - Phone:800-993-8244
Mailing Address - Fax:
Practice Address - Street 1:215 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1843
Practice Address - Country:US
Practice Address - Phone:229-271-9330
Practice Address - Fax:229-271-9245
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN206296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily