Provider Demographics
NPI:1336609163
Name:MISHRA, ANKITA (MD)
Entity type:Individual
Prefix:DR
First Name:ANKITA
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 W COUNTRY CLUB RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5225
Mailing Address - Country:US
Mailing Address - Phone:575-627-0535
Mailing Address - Fax:575-627-5590
Practice Address - Street 1:601 W COUNTRY CLUB RD STE 201
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5225
Practice Address - Country:US
Practice Address - Phone:575-627-0535
Practice Address - Fax:575-627-5590
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2023-1680208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery