Basic Information
| Provider Information | |||||||||
| NPI: | 1164448981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | VALARIE | ||||||||
| MiddleName: | ALDER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7714 POPLAR AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381383941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016830055 | ||||||||
| FaxNumber: | 9019226722 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 STATE DR | ||||||||
| Address2: | |||||||||
| City: | CORINTH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388349324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622863694 | ||||||||
| FaxNumber: | 6622863853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R855711 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 06275325 | 05 | MS | MEDICAID | Q064875 | 05 | TN | MEDICAID |