Individual
KIMBERLY J MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2420 STATE ST, EAST SAINT LOUIS, IL 62205-2321
(618) 318-8809
(618) 615-4205
Mailing address
PO BOX 746715, ATLANTA, GA 30374-6715
(773) 352-1515
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209018150
IL
363LF0000X
Family Nurse Practitioner
Primary
209.018150
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019026962
STATE LICENSE MO
MO
01
—
209.018150
.
IL
Enumeration date
01/18/2019
Last updated
06/06/2025
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