Healthcare Provider Details

I. General information

NPI: 1699113019
Provider Name (Legal Business Name): LAUREN MITCHELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5381 HIGHWAY N STE 101
COTTLEVILLE MO
63304-7750
US

IV. Provider business mailing address

9556 MANCHESTER RD
SAINT LOUIS MO
63119-1313
US

V. Phone/Fax

Practice location:
  • Phone: 636-875-7865
  • Fax:
Mailing address:
  • Phone: 314-961-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020012107
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: