Individual provider Active NPI

Michelle Lee Mitchell, CNP

  • Nurse Practitioner
  • Cincinnati, OH
National Provider Identifier
1619304086
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.14779 Issued in OH
Practice address
3333 Burnet Ave
ML 9016
Cincinnati, OH 45229-3026
Phone
(513) 803-8092
Fax
(513) 803-9245
NPI assigned
Oct 1, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X APRN.CNP.14779 OH
Pediatric Nurse Practitioner 363LP0200X COA.14779-NP OH
Nurse Practitioner 363L00000X APRN.CNP.14779 OH Primary

Addresses

Primary practice location

3333 Burnet Ave
ML 9016
Cincinnati, OH 45229-3026

Mailing address

3333 Burnet Ave
ML 9016
Cincinnati, OH 45229-3026
Phone (513) 803-8092

Other names 1

  • Michelle Pennington Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140305002038 OH Practitioner - Nurse Practitioner 4082844337 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.14779OHMDNurse Practitioner
COA.14779-NPOHMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Medical Center Pediatrics CurrentSince Jan 22, 2014 Accepting new patients

Locations

3341 Solutions Ctr
Chicago, IL 60677

3333 Burnet Ave
#5021
Cincinnati, OH 45229
Phone (513) 636-4225

3333 Burnet Ave
Ste 6015
Cincinnati, OH 45229

3333 Burnet Ave
#9016
Cincinnati, OH 45229
Phone (513) 636-4200

3333 Burnet Ave
Cincinnati, OH 45229
Phone (513) 636-4200

7777 Yankee Rd
#16062
Liberty Township, OH 45044
Phone (513) 636-3200

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1619304086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "address_2": "ML 9016",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-803-8092",
            "fax_number": "513-803-9245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "address_2": "ML 9016",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-803-8092",
            "fax_number": "513-803-9245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "MICHELLE",
        "middle_name": "LEE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-01",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "APRN.CNP.14779",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "COA.14779-NP",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.14779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "PENNINGTON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.