Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 76450 | NC |
N | 363LA2200X | Nurse Practitioner - Adult Health | 76450 | NC |
N | 363LC1500X | Nurse Practitioner - Community Health | 76450 | NC |
N | 363LN0000X | Nurse Practitioner - Neonatal | 76450 | NC |
N | 363LW0102X | Nurse Practitioner - Women's Health | 76450 | NC |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 76450 | NC |
NPI | 1801964978 |
---|---|
Provider Name | Mrs. Jackalyn Lee Mitchell |
First Address | Jacksonville, NC 28540-5311 |
Second Address | Jacksonville, NC 28540-5311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |