Provider Demographics
NPI:1316756018
Name:MITCHELL, CAMISHA (CHW/CPW)
Entity type:Individual
Prefix:
First Name:CAMISHA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CHW/CPW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 HUDSONWOOD DR APT 10206
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6168
Mailing Address - Country:US
Mailing Address - Phone:940-465-1221
Mailing Address - Fax:
Practice Address - Street 1:3505 HUDSONWOOD DR APT 10206
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6168
Practice Address - Country:US
Practice Address - Phone:940-465-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7975172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker