Provider Demographics
NPI:1861892390
Name:MITCHELL, TERI MICHELLE (APRN, CNM, IBCLC)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:MICHELLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN, CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 WADE BLVD STE 630
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6877
Mailing Address - Country:US
Mailing Address - Phone:469-850-2661
Mailing Address - Fax:214-292-6520
Practice Address - Street 1:8501 WADE BLVD STE 630
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:469-850-2661
Practice Address - Fax:214-292-6520
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126152367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife