Provider Demographics
NPI:1366433344
Name:MITCHELL, KATHLEEN BERNICE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:BERNICE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:3815 PLANTATION CT
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-9444
Mailing Address - Country:US
Mailing Address - Phone:804-722-1461
Mailing Address - Fax:804-722-1461
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9132
Practice Address - Fax:804-734-9594
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA214688363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics