Provider Demographics
NPI:1871575886
Name:MITCHELL, KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 N RODNEY PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2462
Mailing Address - Country:US
Mailing Address - Phone:501-228-7200
Mailing Address - Fax:501-228-2285
Practice Address - Street 1:4208 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2462
Practice Address - Country:US
Practice Address - Phone:501-228-7200
Practice Address - Fax:501-228-2285
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5L561OtherAR BLUE CROSS BLUE SHIELD
AR141359001Medicaid
AR11853000000OtherQUALCHOICE
AR5L561Medicare ID - Type Unspecified
AR141359001Medicaid