Provider Demographics
NPI:1629190251
Name:MITCHELL, JASON P (CRNA, MSNA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CRNA, MSNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 OQUINN RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-7018
Mailing Address - Country:US
Mailing Address - Phone:318-728-4037
Mailing Address - Fax:
Practice Address - Street 1:55 OQUINN RD
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-7018
Practice Address - Country:US
Practice Address - Phone:318-728-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN088037 AP0488367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN088037 AP0488OtherLA AP LIC