1861892390 NPI number — DR. TERI MICHELLE MITCHELL APRN, CNM, IBCLC

Table of content: DR. TERI MICHELLE MITCHELL APRN, CNM, IBCLC (NPI 1861892390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861892390 NPI number — DR. TERI MICHELLE MITCHELL APRN, CNM, IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
TERI
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNM, IBCLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861892390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8501 WADE BLVD STE 630
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-6877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-850-2661
Provider Business Mailing Address Fax Number:
214-292-6520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8501 WADE BLVD STE 630
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-850-2661
Provider Business Practice Location Address Fax Number:
214-292-6520
Provider Enumeration Date:
09/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  AP126152 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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