Provider Demographics
NPI:1225140866
Name:MITCHELL, KAREN KYLENE (DPH)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:KYLENE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 58TH ST S
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-7953
Mailing Address - Country:US
Mailing Address - Phone:918-683-3261
Mailing Address - Fax:918-680-3998
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:JACK C MONTGOMERY VAMC MUSKOGEE
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-683-3261
Practice Address - Fax:918-680-3998
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9118OtherSTATE LICESE (PHARMACIST)