MEDICARE: VICTORIA 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	10058678	OR

General Provider Information

NPI Number	:	1508704198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MITCHELL FNP

Provider Business Mailing Address
First Line	:	3011 CORTEZ ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-5611
Country	:	US
Telephone Number	:	423-321-2275
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 CORTEZ ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-5611
Country	:	US
Telephone Number	:	423-321-2275
Fax Number	:

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

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

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