Provider Demographics
NPI:1174710602
Name:MITCHELL, ERIN (PAC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 N MOPAC EXPY STE 2207
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4306
Mailing Address - Country:US
Mailing Address - Phone:512-494-9985
Mailing Address - Fax:512-494-9986
Practice Address - Street 1:6500 N MOPAC EXPY STE 2207
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4306
Practice Address - Country:US
Practice Address - Phone:512-494-9985
Practice Address - Fax:512-494-9986
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y3108OtherBCBX
TX2037087-01Medicaid
1074988OtherNCCPA
TX8Y3108OtherBCBX