Active NPI
Kirklin Tucker Mitchell, PA-C
- Physician Assistant
- Wilmington, DE
National Provider Identifier
1407587835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- C5-0011925
- Practice address
- 700 Foulk Rd
Wilmington, DE 19803-3708 - Phone
- (302) 764-0181
- NPI assigned
- Jun 17, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | OA006145 | PA | |
| Physician Assistant | 363A00000X | C5-0011925 | DE | Primary |
Addresses
Primary practice location
700 Foulk Rd
Wilmington, DE 19803-3708
Mailing address
700 Foulk Rd
Wilmington, DE 19803-3708
Phone (302) 764-0181
Other practice location 1
5651 Limestone Rd
Wilmington, DE 19808-1217
Phone (302) 239-8583
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA, DE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suburban Geriatrics, Inc. | Current | Accepting new patients |
Locations
2901 Jolly Rd
Plymouth Mtng, PA 19462
Phone (610) 272-3222
Organizations & group practices 2
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.
-
- Geriatric Medicine (Internal Medicine) Physician
- Plymouth Meeting, PA
- NPI 1679594808
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731369600000",
"number": "1407587835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 FOULK RD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198033708",
"telephone_number": "302-764-0181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 FOULK RD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198033708",
"telephone_number": "302-764-0181"
}
],
"practiceLocations": [
{
"address_1": "5651 Limestone Rd",
"address_purpose": "LOCATION",
"city": "Wilmington",
"state": "DE",
"postal_code": "198081217",
"country_code": "US",
"telephone_number": "302-239-8583",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MITCHELL",
"first_name": "KIRKLIN",
"middle_name": "TUCKER",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-17",
"last_updated": "2024-11-12",
"certification_date": "2024-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "OA006145",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "DE",
"license": "C5-0011925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.