Healthcare Provider Details

I. General information

NPI: 1265363139
Provider Name (Legal Business Name): KELLY MITCHELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 BUSINESS 141 N
COLEMAN WI
54112-9453
US

IV. Provider business mailing address

347 BUSINESS 141 N
COLEMAN WI
54112-9453
US

V. Phone/Fax

Practice location:
  • Phone: 920-897-2525
  • Fax:
Mailing address:
  • Phone: 920-897-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number15093430
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: