Individual
CHAQUARRA LASTAYSHA MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 E COMMERCE ST, JACKSONVILLE, TX 75766-4910
(903) 535-9041
(903) 586-0001
Mailing address
523 S FANNIN AVE, TYLER, TX 75702-8204
(903) 535-9041
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1179676
TX
Other
Enumeration date
11/13/2024
Last updated
11/13/2024
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