Individual
MR. JONATHAN LAMONT MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 HEYMANN BLVD, LAFAYETTE, LA 70503-2322
(337) 504-4279
Mailing address
1713 PEMBROKE ST, NEW IBERIA, LA 70563-8616
(337) 380-9064
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP08044
LA
Other
Enumeration date
10/17/2014
Last updated
01/12/2015
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