Provider Demographics
NPI:1588285290
Name:MITCHELL, REBECCA WEST (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:WEST
Last Name:MITCHELL
Suffix:
Gender:F
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 1:2040 BEESON RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9757
Mailing Address - Country:US
Mailing Address - Phone:336-817-3790
Mailing Address - Fax:
Practice Address - Street 1:404 WESTWOOD AVE STE 303
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4315
Practice Address - Country:US
Practice Address - Phone:336-905-6060
Practice Address - Fax:336-905-6061
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10110363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant