Basic Information
Provider Information
NPI: 1285999805
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MITCHELL
FirstName: KAREN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHD,PMHNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 311 CAMDEN ST STE 510
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782152015
CountryCode: US
TelephoneNumber: 2105911640
FaxNumber: 2105911635
Practice Location
Address1: 311 CAMDEN ST STE 510
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782152015
CountryCode: US
TelephoneNumber: 2105911640
FaxNumber: 2105911635
Other Information
ProviderEnumerationDate: 07/10/2012
LastUpdateDate: 03/22/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XAP122109TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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