Individual
KIMBERLEE R. MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
600 S MONROE ST, ENID, OK 73701-7211
(580) 233-2300
(580) 548-1489
Mailing address
1705 E 19TH ST, STE 302, TULSA, OK 74104-5410
(580) 748-7585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1288
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200037170A
—
OK
Enumeration date
06/10/2006
Last updated
02/12/2018
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