Provider Demographics
NPI:1700360179
Name:MITCHELL, JESSICA CHRISTINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CHRISTINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:10010 KENNERLY ROAD
Mailing Address - Street 2:3 SOUTHBRIDGE
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128
Mailing Address - Country:US
Mailing Address - Phone:314-525-1328
Mailing Address - Fax:
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-1328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018038623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant