MEDICARE: MS. HOLLY ANN MITCHELL AGNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2026014050	MO

General Provider Information

NPI Number	:	1093653453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY ANN MITCHELL AGNP

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-362-6908
Fax Number	:	314-747-3258

Provider Business Practice Location Address
First Line	:	4921 PARKVIEW PL
Second Line	:	DIV NEUROLOGY MOVEMENT DISORDERS, 7TH FL
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1032
Country	:	US
Telephone Number	:	314-362-6908
Fax Number	:	314-747-3258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	04/27/2026

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