Healthcare Provider Details

I. General information

NPI: 1750945903
Provider Name (Legal Business Name): JENNIFER L MITCHELL APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 N MIAMI AVE
CHOUTEAU OK
74337-3750
US

IV. Provider business mailing address

863 N MIAMI AVE
CHOUTEAU OK
74337-3750
US

V. Phone/Fax

Practice location:
  • Phone: 918-855-9004
  • Fax:
Mailing address:
  • Phone: 918-855-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0064472
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0064472
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: