Provider Demographics
NPI:1437691268
Name:MITCHELL, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S OSAGE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-5143
Mailing Address - Country:US
Mailing Address - Phone:580-491-4790
Mailing Address - Fax:
Practice Address - Street 1:332 S OSAGE ST APT 1
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-5143
Practice Address - Country:US
Practice Address - Phone:580-491-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist