Provider Demographics
NPI:1225633126
Name:MIXON-COOPER, DEBBIE M
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:M
Last Name:MIXON-COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 BRICKYARD BLVD APT 1056
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1348
Mailing Address - Country:US
Mailing Address - Phone:240-273-2140
Mailing Address - Fax:
Practice Address - Street 1:1400 FLORIDA AVE NE APT 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5012
Practice Address - Country:US
Practice Address - Phone:240-273-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant