Individual
DR. TARISHA RENEE MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3401 NORTH BLVD, STE 200-A, BATON ROUGE, LA 70806-3743
(225) 387-0851
(225) 383-8477
Mailing address
8490 PICARDY AVE, BLDG 200, BATON ROUGE, LA 70809-3731
(225) 237-1754
(225) 237-1722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.205942
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2110454
—
LA
01
—
295588YNB7
MEDICARE PTAN
LA
Enumeration date
06/23/2010
Last updated
09/24/2014
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