Provider Demographics
NPI:1699807701
Name:MITCHUSSON, FERRELL LYNN (PERFUSIONIST)
Entity Type:Individual
Prefix:MRS
First Name:FERRELL
Middle Name:LYNN
Last Name:MITCHUSSON
Suffix:
Gender:F
Credentials:PERFUSIONIST
Other - Prefix:MRS
Other - First Name:FERRELL
Other - Middle Name:LYNN
Other - Last Name:MITCHUSSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP
Mailing Address - Street 1:13174 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-8213
Mailing Address - Country:US
Mailing Address - Phone:405-794-2893
Mailing Address - Fax:
Practice Address - Street 1:13174 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-8213
Practice Address - Country:US
Practice Address - Phone:405-794-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK023171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor