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Organization
MISSION HAVEN REDIEMED
Active
Organization
MISSION HAVEN REDIEMED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABI MIKKEL PROVENCE APRN, FNP-BC, FNP-C (OWNER AND PROVIDER)
(817) 992-9791
Entity
Organization
Contact information
Practice address
6108 SHOREWOOD DR, ARLINGTON, TX 76016-2649
(817) 435-2812
Mailing address
PO BOX 170428, ARLINGTON, TX 76003-0428
(817) 435-2812
(817) 719-9236
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
03/13/2023
Last updated
11/27/2023
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