Provider Demographics
NPI:1902353980
Name:MITCHELL, SOMER K
Entity type:Individual
Prefix:
First Name:SOMER
Middle Name:K
Last Name:MITCHELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SOMER
Other - Middle Name:K
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1830 VERSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1402
Mailing Address - Country:US
Mailing Address - Phone:859-347-2412
Mailing Address - Fax:859-346-4641
Practice Address - Street 1:1830 VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1402
Practice Address - Country:US
Practice Address - Phone:859-347-2412
Practice Address - Fax:859-346-4641
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010275363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
13972935OtherCAQH
KY7100521170Medicaid