Healthcare Provider Details

I. General information

NPI: 1700702008
Provider Name (Legal Business Name): KRISTY ROBERTSON MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 S 1ST ST STE C
AUSTIN TX
78745-1119
US

IV. Provider business mailing address

4315 S 1ST ST STE C
AUSTIN TX
78745-1119
US

V. Phone/Fax

Practice location:
  • Phone: 512-947-2168
  • Fax:
Mailing address:
  • Phone: 512-947-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1660593
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1660593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: