Provider Demographics
NPI:1912290362
Name:MITCHELL, JOSEPH MATHEW (DC, NP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MATHEW
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W 39TH 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4005
Mailing Address - Country:US
Mailing Address - Phone:512-371-7478
Mailing Address - Fax:512-371-3861
Practice Address - Street 1:403 STATE HIGHWAY 110 N
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3109
Practice Address - Country:US
Practice Address - Phone:903-839-1000
Practice Address - Fax:903-839-4000
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120784363LA2200X
TX783920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX870N31OtherBCBSTX
TX1912290362OtherBCBSTX
TXTXB151408Medicare PIN
TX870N31OtherBCBSTX