Provider Demographics
NPI:1699334276
Name:MITCHELL, CATHY RICHARDS (FNP-C)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:RICHARDS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 WESTERN BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7637
Mailing Address - Country:US
Mailing Address - Phone:910-333-0283
Mailing Address - Fax:910-333-0513
Practice Address - Street 1:461 WESTERN BLVD STE 122
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7637
Practice Address - Country:US
Practice Address - Phone:910-333-0283
Practice Address - Fax:910-333-0513
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily