Healthcare Provider Details

I. General information

NPI: 1629400254
Provider Name (Legal Business Name): COURTNEY MITCHELL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 RAILROAD ST
BUDA TX
78610-3359
US

IV. Provider business mailing address

2324 TURTLE MOUNTAIN BND
AUSTIN TX
78748-1071
US

V. Phone/Fax

Practice location:
  • Phone: 512-312-5312
  • Fax: 512-312-5313
Mailing address:
  • Phone: 512-373-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number702259
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: