Provider Demographics
NPI:1528656584
Name:MITCHELL, CHARYL M (MSN, RN)
Entity type:Individual
Prefix:MRS
First Name:CHARYL
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13170 OLD JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLACK JACK
Mailing Address - State:MO
Mailing Address - Zip Code:63033-4504
Mailing Address - Country:US
Mailing Address - Phone:314-341-7297
Mailing Address - Fax:
Practice Address - Street 1:13170 OLD JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033-4504
Practice Address - Country:US
Practice Address - Phone:314-341-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008007319163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health