Provider Demographics
NPI:1205577384
Name:MITCHELL, PATTI KAY
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:KAY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20096 E STEELY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-0481
Mailing Address - Country:US
Mailing Address - Phone:918-316-6326
Mailing Address - Fax:
Practice Address - Street 1:20096 E STEELY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0481
Practice Address - Country:US
Practice Address - Phone:918-316-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator