Provider Demographics
NPI:1295127389
Name:MITCHELL, DEBRA
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:KAY
Other - Last Name:SQUIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:29124 BOBCAT DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-5791
Mailing Address - Country:US
Mailing Address - Phone:660-281-6305
Mailing Address - Fax:
Practice Address - Street 1:29124 BOBCAT DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-5791
Practice Address - Country:US
Practice Address - Phone:660-281-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013001853251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health