Individual
MR. JOHNNY MIXON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
733 NW 91ST ST, OKLAHOMA CITY, OK 73114-2801
(405) 885-8225
Mailing address
1317 SAINT MATHEWS DR, MIDWEST CITY, OK 73110-1413
(405) 885-8226
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/08/2022
Last updated
04/08/2022
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