Provider Demographics
NPI:1972283844
Name:MITCHELL, ANDREW DANE RUSSELL (APRN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:DANE RUSSELL
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:204 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1218
Mailing Address - Country:US
Mailing Address - Phone:606-224-6657
Mailing Address - Fax:
Practice Address - Street 1:300 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1704
Practice Address - Country:US
Practice Address - Phone:270-982-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28266641A163WP0808X
KY4028613363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health