MEDICARE: HEATHER JOHNSON MITCHELL RN

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
1	251J00000X	Nursing Care Agency	R004756	OK
2	163W00000X	Registered Nurse	R004756	OK

General Provider Information

NPI Number	:	1669283529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER JOHNSON MITCHELL RN

Provider Business Mailing Address
First Line	:	1725 KINGSBURY LN
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-5313
Country	:	US
Telephone Number	:	405-823-8605
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 KINGSBURY LN
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-5313
Country	:	US
Telephone Number	:	405-823-8605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2025
Last Update Date	:	01/18/2025

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