Mixon, Jerry L

Mixon, Jerry L is an individual health care provider with primary practice located at 4920 Ne Stallings Dr , Nacogdoches TX 75965-1254. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Mixon, Jerry L can be contacted via phone (936) 569-9481.

Contact Information

Primary practice address
4920 Ne Stallings Dr Nacogdoches TX 75965-1254
Phone: (936) 569-9481
Fax: (936) 462-4333
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 227393 Texas

Profile Details

NPI number 1306945944
LBN Legal business name Mixon, Jerry L
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2006
Last updated Mar 2nd, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306945944 NPPES
Texas MEDICAID 088527903
Texas Other 88693U

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