Provider Demographics
NPI:1144286980
Name:MITCHELL, RICKY D (MD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10308
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0308
Mailing Address - Country:US
Mailing Address - Phone:254-554-8773
Mailing Address - Fax:254-554-2018
Practice Address - Street 1:3816 S CLEAR CREEK RD
Practice Address - Street 2:SUITE E
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4400
Practice Address - Country:US
Practice Address - Phone:254-554-8773
Practice Address - Fax:254-554-2018
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193746801Medicaid
316756YVFEMedicare PIN