Provider Demographics
NPI:1497315154
Name:MIXSON, JENNIFER R (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MIXSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 COUNTY ROAD 130
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2221
Mailing Address - Country:US
Mailing Address - Phone:512-635-6200
Mailing Address - Fax:
Practice Address - Street 1:6836 BEE CAVES RD # 310
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5059
Practice Address - Country:US
Practice Address - Phone:512-383-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily