Individual
KORY LANCE MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACUTE CARE NURSE PRA
Contact information
Practice address
3502 9TH ST STE 260, LUBBOCK, TX 79415-5305
(806) 792-8185
(806) 792-9180
Mailing address
5219 CITY BANK PKWY STE 35, LUBBOCK, TX 79407
(806) 761-0333
(806) 782-0097
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
663921
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP114881
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151566101
FIRSTCARE
—
05
—
45939268
—
NM
01
—
8Y1753
BCBS OF TEXAS
TX
01
—
8Y5044
BCBS OF TEXAS
TX
Enumeration date
11/13/2006
Last updated
08/29/2022
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