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General NPI Number Information
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NPI Number | 1164394813
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Entity Type | Individual
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Provider Name | MALLORY KITCHELL APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 604 S 2ND ST
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City | MCALESTER
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State | OK
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Zip | 74501-5814
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Country | US
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Telephone | 539-316-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 655 E OKMULGEE ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-5529
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Country | US
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Telephone | 918-915-7575
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Fax | 918-915-7576
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 225064
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License Number State | OK
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