Healthcare Provider Details

I. General information

NPI: 1164342416
Provider Name (Legal Business Name): ADAM JAMES MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 RIPA AVE
SAINT LOUIS MO
63125-2378
US

IV. Provider business mailing address

2212 HICKORY ST
SAINT LOUIS MO
63104-2417
US

V. Phone/Fax

Practice location:
  • Phone: 314-544-1111
  • Fax:
Mailing address:
  • Phone: 573-837-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2026034005
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: