Provider Demographics
NPI:1568357036
Name:MITCHELL, DEANDRA (LVN)
Entity type:Individual
Prefix:
First Name:DEANDRA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17304 PRESTON RD STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5645
Mailing Address - Country:US
Mailing Address - Phone:214-865-6165
Mailing Address - Fax:972-972-8343
Practice Address - Street 1:17304 PRESTON RD STE 800
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5645
Practice Address - Country:US
Practice Address - Phone:214-865-6165
Practice Address - Fax:972-972-8343
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327052164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty