MEDICARE: KIMBERLY ANNE MITCHELL FNP

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	2021039897	MO

General Provider Information

NPI Number	:	1124790878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE MITCHELL FNP

Provider Business Mailing Address
First Line	:	102 E MARION ST
Second Line	:
City	:	PARIS
State	:	MO
Zip	:	65275-1041
Country	:	US
Telephone Number	:	660-327-4911
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 E MARION ST
Second Line	:
City	:	PARIS
State	:	MO
Zip	:	65275-1041
Country	:	US
Telephone Number	:	660-327-4911
Fax Number	:	660-327-5501

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

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	04/19/2024

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