=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376028472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBYN MITCHELL AGACNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2018
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 504 ELM ST NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87102-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-692-3555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23066 HIGH RD
-----------------------------------------------------
City | OAKWOOD VILLAGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44146-6140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-215-7925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | .023678
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 63000
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------