Individual provider Active NPI

Braylin Mitchell, LE

  • Specialist
  • Portland, OR
National Provider Identifier
1124842844
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
BAP-E-10249925 Issued in OR
Practice address
16239 SE McLoughlin Blvd Ste 208
Portland, OR 97267-4654
Phone
(971) 322-5909
NPI assigned
Nov 9, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X BAP-E-10249925 OR Primary
Specialist 174400000X 9964 CA

Addresses

Primary practice location

16239 SE McLoughlin Blvd Ste 208
Portland, OR 97267-4654

Mailing address

13424 SE 169TH Ave Apt A112
Happy Valley, OR 97015-8744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9964CAMDOptometrist
BAP-E-10249925ORMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Glimmer Electrolysis LLC Specialist CurrentSince Jun 29, 2025 Accepting new patients

Locations

16239 SE McLoughlin Blvd
Ste 208
Portland, OR 97267
Phone (971) 206-4776

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1124842844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13424 SE 169TH AVE APT A112",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970158744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16239 SE MCLOUGHLIN BLVD STE 208",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972674654",
            "telephone_number": "971-322-5909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "BRAYLIN",
        "credential": "LE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-09",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "BAP-E-10249925",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "9964",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.