Keith Wallace Mitchell Jr., RN

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

68085 Issued in ME

Practice address

118 Northport Ave
Belfast, ME 04915-6072

Phone

(207) 505-4123

NPI assigned

Sep 21, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1750169538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 WALTER ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016234",
            "telephone_number": "207-902-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 NORTHPORT AVE",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049156072",
            "telephone_number": "207-505-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KEITH",
        "middle_name": "WALLACE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-21",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "ME",
            "license": "68085",
            "primary": false
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "ME",
            "license": "68085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Metcalf
• Peter S Millard, MD
• Karen P Miller, M.D.
• Joan G Mills, RPH
• Justin Robert Mitchell, DPT
• Joanne Marie Moesswilde, FNP
• Lanae J. Moline, M.A., CCC-SLP/A
• Matthew Scott Molison, DO
• Benjamin Daniel Moore, MD
• Mary Moran, MD

• Emergency Registered Nurse in Belfast, ME
• Providers in Belfast, ME by specialty
• Emergency Registered Nurse in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.