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NPI Code Detail

MEDICARE: GRACE MITCHELL APRN, CNP

MEDICARE: GRACE MITCHELL APRN, CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner106608OK

General Provider Information

NPI Number : 1245691021
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE MITCHELL APRN, CNP
Provider Business Mailing Address
First Line : 400 N EASTERN AVE
Second Line :
City : MOORE
State : OK
Zip : 73160-5833
Country : US
Telephone Number : 405-602-6291
Fax Number :
Provider Business Practice Location Address
First Line : 2921 SW 89TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-6332
Country : US
Telephone Number : 405-757-7818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2016
Last Update Date : 03/08/2016

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