Healthcare Provider Details

I. General information

NPI: 1427614692
Provider Name (Legal Business Name): HUNTER LEIGH MITCHELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 105B
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7960
  • Fax: 314-989-0235
Mailing address:
  • Phone: 314-996-7960
  • Fax: 314-989-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number202505419
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME165433
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number323713
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: