Provider Demographics
NPI:1720647035
Name:MITCHELL, KIA ANESIA (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:ANESIA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 CLOUD LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2257
Mailing Address - Country:US
Mailing Address - Phone:404-789-0900
Mailing Address - Fax:
Practice Address - Street 1:2657 CLOUD LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-2257
Practice Address - Country:US
Practice Address - Phone:404-789-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW51662174H00000X
MDAC002764363LF0000X
MDAC005185363LP0808X
GARN187184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174H00000XOther Service ProvidersHealth Educator
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health