Healthcare Provider Details

I. General information

NPI: 1508704198
Provider Name (Legal Business Name): VICTORIA MITCHELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 S 6TH ST
KLAMATH FALLS OR
97601-4340
US

IV. Provider business mailing address

2340 S 6TH ST
KLAMATH FALLS OR
97601-4340
US

V. Phone/Fax

Practice location:
  • Phone: 541-204-4493
  • Fax: 541-851-2108
Mailing address:
  • Phone: 541-204-4493
  • Fax: 541-851-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10058678
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: