Provider Demographics
NPI:1619850773
Name:GMITTER, MIKAYLA JADE
Entity type:Individual
Prefix:MS
First Name:MIKAYLA
Middle Name:JADE
Last Name:GMITTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W 5TH ST APT 2317
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2856
Mailing Address - Country:US
Mailing Address - Phone:269-815-2157
Mailing Address - Fax:
Practice Address - Street 1:400 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7617
Practice Address - Country:US
Practice Address - Phone:269-815-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS