Healthcare Provider Details

I. General information

NPI: 1881117539
Provider Name (Legal Business Name): KIMBERLY J MITCHELL NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W3985 COUNTY ROAD NN
ELKHORN WI
53121-4337
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 262-741-2000
  • Fax:
Mailing address:
  • Phone: 262-741-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number237097-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number7912-33
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7912
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: