Provider Demographics
NPI:1467175430
Name:MIXON, DENISE M
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:M
Last Name:MIXON
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 1:6007 REGAL CREST DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7935
Mailing Address - Country:US
Mailing Address - Phone:804-387-9058
Mailing Address - Fax:
Practice Address - Street 1:6007 REGAL CREST DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-7935
Practice Address - Country:US
Practice Address - Phone:804-387-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty