Healthcare Provider Details

I. General information

NPI: 1245796218
Provider Name (Legal Business Name): ERICA MITCHELL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 POLARIS PKWY STE 200
WESTERVILLE OH
43082-8213
US

IV. Provider business mailing address

460 POLARIS PKWY STE 200
WESTERVILLE OH
43082-8213
US

V. Phone/Fax

Practice location:
  • Phone: 614-797-0547
  • Fax: 614-737-5748
Mailing address:
  • Phone: 614-797-0547
  • Fax: 614-737-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1034391
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: