Individual
STEPHEN G MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1970 N HWY 190, COVINGTON, LA 70433-5158
(985) 400-5988
(985) 867-3644
Mailing address
PO BOX 3370, COVINGTON, LA 70434-3370
(985) 400-5988
(985) 867-3644
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN073581 AP03978
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1471712
—
LA
Enumeration date
02/27/2006
Last updated
03/31/2021
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