Mission Haven Rediemed

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MISSION HAVEN REDIEMED

Practice address

6108 Shorewood Dr
Arlington, TX 76016-2649

Phone

(817) 435-2812

NPI assigned

Mar 13, 2023

Organization subpart

No

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

Authorized official

Name

Abi Mikkel Provence, APRN, FNP-BC, FNP-CNPI 1922587872

Title

Owner and Provider

Phone

(817) 992-9791

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abi Mikkel Provence, MSN, FNP-BC & FNP-C

  • Primary Care Nurse Practitioner
  • Arlington, TX
  • NPI 1922587872
  NPD Authorized official

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1558062059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 170428",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760030428",
            "telephone_number": "817-435-2812",
            "fax_number": "817-719-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6108 SHOREWOOD DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760162649",
            "telephone_number": "817-435-2812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2117 Brentgate Dr",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760171611",
            "country_code": "US",
            "telephone_number": "817-435-2812",
            "fax_number": "817-719-9236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MISSION HAVEN REDIEMED",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "PROVENCE",
        "authorized_official_first_name": "ABI",
        "authorized_official_middle_name": "MIKKEL",
        "authorized_official_title_or_position": "OWNER AND PROVIDER",
        "authorized_official_telephone_number": "817-992-9791",
        "authorized_official_credential": "APRN, FNP-BC, FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelo James Angeles Misajon, DPT
• Sushila Mishra, FNP
• Mismo Derm and Wound TX Ed PLLC
• Mismo Skin and Wound Institute TX
• Mission Care Hospice LLC
• Mission Metroplex, Inc.
• Angela Diane Mitchell, PH.D
• Annisa Mitchell
• Cheryl D. Mitchell, AG-ACNP-BC
• Mary Ann Mitchell, LPC

• Family Medicine Physician in Arlington, TX
• Providers in Arlington, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.