Healthcare Provider Details

I. General information

NPI: 1649956525
Provider Name (Legal Business Name): MITCHELL NICHOLS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 RUNNING HORSE RD
PLATTE CITY MO
64079-7707
US

IV. Provider business mailing address

2703 RUNNING HORSE RD
PLATTE CITY MO
64079-7707
US

V. Phone/Fax

Practice location:
  • Phone: 816-858-7050
  • Fax: 816-858-7055
Mailing address:
  • Phone: 816-858-7050
  • Fax: 816-858-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026001700
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: