Healthcare Provider Details

I. General information

NPI: 1912578832
Provider Name (Legal Business Name): MISTY MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W 9TH ST
WALDRON AR
72958-7526
US

IV. Provider business mailing address

257 W 9TH ST
WALDRON AR
72958-7526
US

V. Phone/Fax

Practice location:
  • Phone: 479-207-0559
  • Fax:
Mailing address:
  • Phone: 479-207-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: