Individual
KATHY MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
332 S OSAGE ST APT 1, PONCA CITY, OK 74601-5143
(580) 491-4790
Mailing address
332 S OSAGE ST APT 1, PONCA CITY, OK 74601-5143
(580) 491-4790
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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