Healthcare Provider Details

I. General information

NPI: 1497739775
Provider Name (Legal Business Name): MITCHELL PARKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6039 BERRY ST
FORT SILL OK
73503-4445
US

IV. Provider business mailing address

6039 BERRY ST
FORT SILL OK
73503-4445
US

V. Phone/Fax

Practice location:
  • Phone: 580-442-2268
  • Fax:
Mailing address:
  • Phone: 580-442-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61456
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: