Individual
GINA H MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1220 JEFFERSON ST, LAUREL, MS 39440-4355
(601) 426-4086
(601) 426-4417
Mailing address
11 PLACE ROAD, ELLISVILLE, MS 39437
(601) 426-4086
(601) 426-4417
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D0722
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06023396
—
MS
Enumeration date
08/02/2005
Last updated
11/03/2010
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