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General NPI Number Information
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NPI Number | 1578258307
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Entity Type | Individual
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Provider Name | KIMBERLY SUE MITCHELL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 1700 WILDCAT DR STE B
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City | PORTLAND
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State | TX
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Zip | 78374-2838
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Country | US
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Telephone | 361-704-6368
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Fax |
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Provider Business Mailing Address
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Address Line | 5014 COUNTY ROAD 2015
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City | ODEM
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State | TX
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Zip | 78370-4497
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1097231
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License Number State | TX
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