Provider Demographics
NPI:1578815734
Name:MITCHELL, JESSICA MARIE
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARIE
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 1:8017 S WHEELING AVE
Mailing Address - Street 2:APT. O
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5230
Mailing Address - Country:US
Mailing Address - Phone:918-382-4469
Mailing Address - Fax:918-382-3434
Practice Address - Street 1:311 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3208
Practice Address - Country:US
Practice Address - Phone:918-582-0061
Practice Address - Fax:918-382-3434
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator