Provider Demographics
NPI:1902635477
Name:MITCHELL, SEARAE DAWN
Entity type:Individual
Prefix:
First Name:SEARAE
Middle Name:DAWN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12912 FIREROCK CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-3316
Mailing Address - Country:US
Mailing Address - Phone:405-365-2694
Mailing Address - Fax:
Practice Address - Street 1:12912 FIREROCK CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-3316
Practice Address - Country:US
Practice Address - Phone:405-365-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty