Provider Demographics
NPI:1861104861
Name:MITCHELL, CYNDI
Entity type:Individual
Prefix:
First Name:CYNDI
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:
Other - Last Name:KAPLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1339 S SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3459
Mailing Address - Country:US
Mailing Address - Phone:423-994-7098
Mailing Address - Fax:
Practice Address - Street 1:4747 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-1739
Practice Address - Country:US
Practice Address - Phone:316-529-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-141526-082163W00000X
OKR0135447163W00000X
KS53-81704-082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse