| Doctor Name: | MS. JACEY LAINE MITCHELL |
| NPI Number: | 1003895160 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. MSN, CFNP |
| License Number: | AP2231 |
| Business Practice Address: | 1608 Stockton Hill Road #101 Kingman, AZ - 864014142 |
| Business Phone Number: | 9283771984 |
| Business Fax Number: | 9283771983 |
| Mailing Address: | 1608 Stockton Hill Road #101, KINGMAN |
| State: | AZ |
| Postal Code: | 864014142 |
| Phone Number: | 9283771984 |
| Fax Number: | 9283771983 |
| NPI Enumeration Date: | 01/16/2006 |
| NPI Last Update Date: | 11/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP2231 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |