Provider Demographics
NPI:1780668954
Name:MITCHELL, MARY ELLEN (MSN,FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSN,FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:ROWSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:DIGESTIVE HEALTH SPECIALISTS, PA
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0021
Mailing Address - Country:US
Mailing Address - Phone:662-680-5565
Mailing Address - Fax:662-840-8636
Practice Address - Street 1:589 GARFIELD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6301
Practice Address - Country:US
Practice Address - Phone:662-680-5565
Practice Address - Fax:662-840-8636
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0126313Medicaid
MS0355656-22OtherANCC CERTIFICATION FNP
MSR863519OtherRN LICENSE NUMBER
MS500001122Medicare PIN
MS0126313Medicaid
MS500001122Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #