Active NPI
Sandra Kay Mitchell
- Attendant Care Provider
- Wynne, AR
National Provider Identifier
1790950103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- Practice address
- 324 Mulberry Ave W
Wynne, AR 72396-2813 - Phone
- (807) 208-5444
- NPI assigned
- Apr 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | Primary |
Addresses
Primary practice location
324 Mulberry Ave W
Wynne, AR 72396-2813
Mailing address
324 Mulberry Ave W
Wynne, AR 72396-2813
Phone (807) 208-5444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 166087783 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209081600000",
"number": "1790950103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 MULBERRY AVE W",
"city": "WYNNE",
"state": "AR",
"postal_code": "723962813",
"telephone_number": "807-208-5444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 MULBERRY AVE W",
"city": "WYNNE",
"state": "AR",
"postal_code": "723962813",
"telephone_number": "807-208-5444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "SANDRA",
"middle_name": "KAY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-25",
"last_updated": "2008-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "166087783",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wynne, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.