Stacey Lasandra Mitchell, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

203475 Issued in GA

Practice address

320 Lanier Ave W Ste 200
Fayetteville, GA 30214-7443

Phone

(678) 590-1232

Fax

(470) 381-1502

NPI assigned

Jan 23, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Stacey Lasandra Coleman Former name

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thrivemyndxercize PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Brooklyn, NY
  • NPI 1407680093
  NPD Authorized official
• Columbus Ambulatory Healthcare Services, Inc.

  • Family Medicine Physician
  • Columbus, GA
  • NPI 1790733244
  NPD
• Piedmont Athens Hospitalist Physicians LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1578079000
  NPD
• Piedmont Hospitalist Physicians LLC

  • Family Medicine Physician
  • Stockbridge, GA
  • NPI 1548219660
  NPD
• Columbus Ambulatory Healthcare Services, Inc.

  • Family Medicine Physician
  • Phenix City, AL
  • NPI 1699240531
  NPD
• Counseling Services for Wellbeing, Inc.

  • Marriage & Family Therapist
  • Burien, WA
  • NPI 1588080626
  NPD
• East Point Medical PC

  • Family Medicine Physician
  • Maspeth, NY
  • NPI 1518571751

  Psychiatric/Mental Health

  NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Psychiatric/Mental Health

  NPD
• Livingston County

  • Community Based Hospice Care Agency
  • Mount Morris, NY
  • NPI 1326060724
  NPD
• Livingston County

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Geneseo, NY
  • NPI 1578656302
  NPD
• Piedmont Athens Specialty Care LLC

  • Cardiovascular Disease Physician
  • Athens, GA
  • NPI 1184130627
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1245794387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 HIGHWAY 85 N STE 310-390",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147738",
            "fax_number": "470-381-1502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 LANIER AVE W STE 200",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147443",
            "telephone_number": "678-590-1232",
            "fax_number": "470-381-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "STACEY",
        "middle_name": "LASANDRA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403153",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "203475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1245794387",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Fayetteville",
            "affiliation": "N",
            "address_1": "1415 Highway 85 N Ste 310-390",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302147738",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smitchellnp@mymentalheal.org",
            "affiliation": "N",
            "endpointDescription": "smitchellnp@mymentalheal.org",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "beautifulmindsfayetteville@gmail.com",
            "address_1": "320 Lanier Ave W Ste 200",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302147443",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smitchellnp@mymentalheal.org",
            "affiliation": "N",
            "endpointDescription": "smitchellnp@mymentalheal.org",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "beautifulmindsfayetteville@gmail.com",
            "address_1": "320 Lanier Ave W Ste 200",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302147443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "COLEMAN",
            "middle_name": "LASANDRA",
            "prefix": "MISS",
            "credential": "APRN, PMHNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mindset Healthcare, PC
• Beverlyn Ming
• April Jordan Mitchell, FNP-C
• Barbara Grady Mitchell, DDS
• Carlton Wendell Mitchell, LPC (PLLC)
• Steven Allgood Mitchell, DDS
• Tiara Mitchell, RBT
• Prabhakar Mithal
• Mobley Riverdale Eye Clinic Inc
• Christen Machela Mobley

• Psychiatric/Mental Health Nurse Practitioner in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.