Provider Demographics
NPI:1962786731
Name:MOKRYCKI, MISTY (APRN)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:MOKRYCKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CROSSBOW LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-6720
Mailing Address - Country:US
Mailing Address - Phone:937-477-2586
Mailing Address - Fax:
Practice Address - Street 1:2591 MIAMISBURG CENTERVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3706
Practice Address - Country:US
Practice Address - Phone:937-439-5252
Practice Address - Fax:937-439-9242
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12419363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080919Medicaid