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Individual provider Active NPI

Kory Lance Mitchell, ACUTE CARE NURSE PRA

  • Acute Care Nurse Practitioner
  • Lubbock, TX
National Provider Identifier
1588735104
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP114881 Issued in TX
Practice address
3502 9TH St Ste 260
Lubbock, TX 79415-5305
Phone
(806) 792-8185
Fax
(806) 792-9180
NPI assigned
Nov 13, 2006
Last updated
Aug 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 663921 TX
Acute Care Nurse Practitioner 363LA2100X AP114881 TX Primary

Addresses

Primary practice location

3502 9TH St Ste 260
Lubbock, TX 79415-5305

Mailing address

5219 City Bank Pkwy Ste 35
Lubbock, TX 79407
Phone (806) 761-0333

Other identifiers 4

IdentifierTypeStateIssuer
8Y1753OtherTXBCBS OF TEXAS
45939268MedicaidNM
8Y5044OtherTXBCBS OF TEXAS
151566101OtherFIRSTCARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kory.mitchell@direct.myteamcare.com UMC Physicians

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070919000268 TX Practitioner - Nurse Practitioner 0749374932 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umc PhysiciansGroup PAC ID 9830003631, 107 clinicians

Practice addresses (Care Compare)

3502 9TH St
Suite 260
Lubbock, TX 79415-5305
Phone (806) 792-8185

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
663921TXMDMedical-Surgical Registered Nurse

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1588735104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 CITY BANK PKWY STE 35",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79407",
            "telephone_number": "806-761-0333",
            "fax_number": "806-782-0097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 9TH ST STE 260",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794155305",
            "telephone_number": "806-792-8185",
            "fax_number": "806-792-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KORY",
        "middle_name": "LANCE",
        "credential": "ACUTE CARE NURSE PRA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "TX",
            "license": "663921",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP114881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "8Y1753",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45939268",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "8Y5044",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE",
            "identifier": "151566101",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kory.mitchell@direct.myteamcare.com",
            "affiliation": "Y",
            "affiliationName": "UMC Physicians",
            "address_1": "3502 9th St Ste 260",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794155305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.