Individual
TARA MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2370 GAUSE BOULEVARD, SLIDELL, LA 70464
(985) 639-3755
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
27112
AL
208000000X
Pediatrics Physician
Primary
MD.202215
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009910486
—
AL
05
—
03585311
—
MS
05
—
1151441
—
LA
Enumeration date
05/21/2007
Last updated
12/17/2008
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