Healthcare Provider Details

I. General information

NPI: 1962786731
Provider Name (Legal Business Name): MISTY MOKRYCKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 MIAMISBURG CENTERVILLE RD STE 201
DAYTON OH
45459-3706
US

IV. Provider business mailing address

900 CROSSBOW LN
TROY OH
45373-6720
US

V. Phone/Fax

Practice location:
  • Phone: 937-439-5252
  • Fax: 937-439-9242
Mailing address:
  • Phone: 937-477-2586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number12419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: