Provider Demographics
NPI:1215724455
Name:MITCHELL, AMBER MARIE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 REGENCY RD.
Mailing Address - Street 2:
Mailing Address - City:DAVIN
Mailing Address - State:WV
Mailing Address - Zip Code:25617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 REGENCY RD.
Practice Address - Street 2:
Practice Address - City:DAVIN
Practice Address - State:WV
Practice Address - Zip Code:25617
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant