Individual
KELLY PRINCE MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
116 MIMOSA DR, THOMASVILLE, GA 31792-6605
(229) 584-5570
(229) 551-8697
Mailing address
116 MIMOSA DR, THOMASVILLE, GA 31792-6605
(229) 584-5570
(229) 551-8697
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN254729
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056052474
DRIVERS LICENSE
GA
Enumeration date
03/31/2021
Last updated
11/13/2023
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