Individual
KENNETH ALLEN MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6025 LAKE RD, SUITE 200, WOODBURY, MN 55125-1712
(651) 999-6800
(651) 999-6830
Mailing address
1300 CENTERVIEW DR, LITTLE ROCK, AR 72211-4349
(501) 219-8900
(501) 410-1148
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10025
MN
363A00000X
Physician Assistant
Primary
PA970
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
534141800
—
MN
Enumeration date
10/10/2005
Last updated
04/05/2021
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