Provider Demographics
NPI:1104121409
Name:MITCHELL, KRISTINA OREY (MD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:OREY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 5TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3307
Mailing Address - Country:US
Mailing Address - Phone:903-596-3862
Mailing Address - Fax:903-590-5005
Practice Address - Street 1:1000 E 5TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3307
Practice Address - Country:US
Practice Address - Phone:903-596-3862
Practice Address - Fax:903-590-5005
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics