Provider Demographics
NPI:1285081752
Name:MITCHELL, WILLIAM D (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:M
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 1:2913 DESIARD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7207
Mailing Address - Country:US
Mailing Address - Phone:318-388-1250
Mailing Address - Fax:318-651-8980
Practice Address - Street 1:2913 BETIN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7257
Practice Address - Country:US
Practice Address - Phone:318-651-0041
Practice Address - Fax:318-651-8980
Is Sole Proprietor?:No
Enumeration Date:2016-05-15
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK135663363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA324084OtherLA STATE MEDICAL BOARD
AK135663OtherSTATE LICENSE