Individual
KELLY MIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1361 W FREMONT ST, GALESBURG, IL 61401-2436
(309) 344-2225
Mailing address
530 HILLBROOK EST, GALESBURG, IL 61401-8439
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209014389
IL
Other
Enumeration date
06/28/2016
Last updated
06/28/2016
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