Provider Demographics
NPI:1831277573
Name:MITCHELL, NIKKI JO (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:JO
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6544 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9778
Mailing Address - Country:US
Mailing Address - Phone:812-660-0708
Mailing Address - Fax:
Practice Address - Street 1:4488 ROSLIN RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8590
Practice Address - Country:US
Practice Address - Phone:812-996-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002315A363L00000X, 363LF0000X
IN71002315363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000654612OtherBCBS #
KY7100104280Medicaid
IN200845810Medicaid
KY7100104280Medicaid
IN200845810Medicaid