Provider Demographics
NPI:1841377512
Name:MITCHELL, CRYSTAL ELISABETH (PA-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ELISABETH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2540
Mailing Address - Country:US
Mailing Address - Phone:304-466-2501
Mailing Address - Fax:304-466-2513
Practice Address - Street 1:197 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2540
Practice Address - Country:US
Practice Address - Phone:304-466-2501
Practice Address - Fax:304-466-2513
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV781363A00000X
WV1225363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical