Individual
MARYLYN MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
2120 BROKEN SHOE TRL, TEMPLE, TX 76502-0085
(254) 228-6062
Mailing address
2120 BROKEN SHOE TRL, TEMPLE, TX 76502-0085
(254) 228-6062
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1000062
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000062
TEXAS NP LICENSE NUMBER
TX
Enumeration date
07/06/2020
Last updated
07/06/2020
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