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General NPI Number Information
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NPI Number | 1417810144
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Entity Type | Individual
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Provider Name | AUDREY GRACE MITCHELL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1000 E PRIMROSE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5154
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Country | US
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Telephone | 417-269-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 123 N GLENGARY DR
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City | NIXA
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State | MO
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Zip | 65714-7798
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Country | US
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Telephone | 417-830-5136
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2025033787
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License Number State | MO
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