Provider Demographics
NPI:1932956141
Name:MITCHEM, KRISTEN (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MITCHEM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-9127
Mailing Address - Country:US
Mailing Address - Phone:850-336-2647
Mailing Address - Fax:
Practice Address - Street 1:6024 SPIKES WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-2827
Practice Address - Country:US
Practice Address - Phone:850-336-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031667363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health