Provider Demographics
NPI:1013617505
Name:DAVIS-MITCHELL, ALEXANDRIA BROOK (FNP-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:BROOK
Last Name:DAVIS-MITCHELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 BROOKLINE CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5583
Mailing Address - Country:US
Mailing Address - Phone:719-469-0674
Mailing Address - Fax:
Practice Address - Street 1:41 MONTEBELLO RD STE 116
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1366
Practice Address - Country:US
Practice Address - Phone:719-423-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-179499363LF0000X
COAPN.0998517-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily