Kelly Ann Mitchell, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810003058 Issued in VA

Practice address

158 Front Royal Pike
Suite 200
Winchester, VA 22602-4346

Phone

(540) 667-8888

Fax

(540) 667-5663

NPI assigned

Jul 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Northwestern Community Services Board

  • Community/Behavioral Health Agency
  • Front Royal, VA
  • NPI 1215930573
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1619908183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 FRONT ROYAL PIKE",
            "address_2": "SUITE 200",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226024346",
            "telephone_number": "540-667-8888",
            "fax_number": "540-667-5663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 FRONT ROYAL PIKE",
            "address_2": "SUITE 200",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226024346",
            "telephone_number": "540-667-8888",
            "fax_number": "540-667-5663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810003058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mission Functional Medicine, PLLC
• Wilson Tyler Mistr, DDS
• Elizabeth Colleen Mistretta
• Debra Mitchell, DIETIAN
• Kaylin Lintz Mitchell
• Rebecca Mitchell, MSW
• Simone Mitchell, CNM
• Mithril Ministrations LLC
• Steven Mitkowski
• Mlpa Inc

• Clinical Psychologist in Winchester, VA
• Providers in Winchester, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.