Healthcare Provider Details

I. General information

NPI: 1649725987
Provider Name (Legal Business Name): BETTY MITCHELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HIGHWAY K
O FALLON MO
63366-8431
US

IV. Provider business mailing address

1101 HIGHWAY K
O FALLON MO
63366-8431
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-6363
  • Fax:
Mailing address:
  • Phone: 636-379-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016029270
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016029270
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: