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General NPI Number Information
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NPI Number | 1881426716
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Entity Type | Individual
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Provider Name | REBECCA LEE MITCHAM AGNP-C, RN
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Gender | Female
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 3800 S W S YOUNG DR STE 201
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City | KILLEEN
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State | TX
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Zip | 76542-3340
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Country | US
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Telephone | 254-245-9175
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11538
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City | KILLEEN
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State | TX
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Zip | 76547-1538
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Country | US
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Telephone | 254-245-9175
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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 | 1173843
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 219787
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 244088
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License Number State | MT
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