Kimberly J Mitchell

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.018150 Issued in IL

Practice address

2420 State St
East Saint Louis, IL 62205-2321

Phone

(618) 318-8809

Fax

(618) 615-4205

NPI assigned

Jan 18, 2019

Last updated

Jun 6, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MO, IL, IN3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Osh-Il Physicians Group LLCGroup PAC ID 3870877699, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HSHS St Elizabeth's Hospital Hospital, O Fallon, IL, CCN 140187

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ms_kmitc119@landmarkhealth-direct.org

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.

• Osh-Il Physicians Group LLC

  • Primary Care Clinic/Center
  • East Saint Louis, IL
  • NPI 1265977698

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Midwest Post Acute Care PLLC

  • Nurse Practitioner
  • Chicago, IL
  • NPI 1083012074

  IN

  Medicare reassignment NPD
• Karefirst Missouri PC

  • Nurse Practitioner
  • Saint Peters, MO
  • NPI 1942658943
  Medicare reassignment NPD
• Oak Street Health Physicians Group of Missouri, LLC

  • Primary Care Clinic/Center
  • Saint Louis, MO
  • NPI 1669041760

  Nurse Practitioner

  Medicare reassignment NPD

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

• St Elizabeths Hospital of the Hospital Sisters of the Third Order

  dba HSHS St. Elizabeth's Hospital

  • General Acute Care Hospital
  • O'Fallon, IL
  • NPI 1629057302
  Care Compare affiliation

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1700350170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746715",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746715",
            "telephone_number": "773-352-1515",
            "fax_number": "312-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622052321",
            "telephone_number": "618-318-8809",
            "fax_number": "618-615-4205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4625 Lindell Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631083725",
            "country_code": "US",
            "telephone_number": "866-949-0108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Westbrook Corporate Ctr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Westchester",
            "state": "IL",
            "postal_code": "601545709",
            "country_code": "US",
            "telephone_number": "866-949-0108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3354 Jerome Ln",
            "address_purpose": "LOCATION",
            "city": "Cahokia",
            "state": "IL",
            "postal_code": "622062604",
            "country_code": "US",
            "telephone_number": "618-484-7850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 Kennedy Dr",
            "address_purpose": "LOCATION",
            "city": "Granite City",
            "state": "IL",
            "postal_code": "62040",
            "country_code": "US",
            "telephone_number": "618-504-0908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-18",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209018150",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.018150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE MO",
            "identifier": "2019026962",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": ".",
            "identifier": "209.018150",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Cahokia",
            "affiliation": "N",
            "address_1": "3354 Jerome Ln",
            "city": "Cahokia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622062604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": ".",
            "affiliation": "N",
            "address_1": "5 Kennedy Dr",
            "city": "Granite City",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620401851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Terica Meeks, NP
• Metropolitan Diagnostics
• Thomas Mikkelson, MD
• Latasha Miller
• Elon Hymees Mitchell
• Kischa Moton
• Narsimha R Muddasani, M.D.
• Chennaiah Nadindla, MD
• Margaret M Nahass, PA-C, RN
• Nathan Health Care Center, L.L.C.

• Family Nurse Practitioner in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.