Fonda Renee Mitchell, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA 2313 Issued in AR

Practice address

208 Lilac Dr
El Dorado, AR 71730-8318

Phone

(870) 918-6675

NPI assigned

Nov 6, 2014

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415232000000",
    "number": "1639575434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 LILAC DR",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717308318",
            "telephone_number": "870-918-6675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 LILAC DR",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717308318",
            "telephone_number": "870-918-6675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "FONDA",
        "middle_name": "RENEE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-06",
        "last_updated": "2014-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "PTA 2313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Miller
• Marsha Requita Miller, APRN
• Shawana Miller
• Donna L Miner
• Misenheimer Medical, LLC
• Mobley Medical Clinic PLLC
• Jessica P Mobley, APN
• Requebia Monk
• Shakerah Moody
• Andi Moore, DPT

• Physical Therapy Assistant in El Dorado, AR
• Providers in El Dorado, AR by specialty
• Physical Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; 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.