Healthcare Provider Details

I. General information

NPI: 1710800834
Provider Name (Legal Business Name): MALLORY KITCHELL PMHNP-BC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2498 HARTSHORNE LAKE RD
HARTSHORNE OK
74547-5094
US

IV. Provider business mailing address

2498 HARTSHORNE LAKE RD
HARTSHORNE OK
74547-5094
US

V. Phone/Fax

Practice location:
  • Phone: 918-297-6444
  • Fax:
Mailing address:
  • Phone: 918-297-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MALLORY KITCHELL
Title or Position: OWNER
Credential: PMHNP
Phone: 918-297-6444