Individual
SALLY ANN MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAA
Contact information
Practice address
1102 W 32ND ST, JOPLIN, MO 64804-3503
(417) 347-5222
Mailing address
FPHO MANAGED CARE, 1102 WEST 32ND STREET, JOPLIN, MO 64804
(417) 347-5033
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
003351
GA
367H00000X
Anesthesiologist Assistant
Primary
2024023954
MO
367H00000X
Anesthesiologist Assistant
75000008A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000298B
—
DC
Enumeration date
10/26/2006
Last updated
09/18/2024
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