Provider Demographics
NPI:1659268548
Name:MIXON, JERRI ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:ELIZABETH
Last Name:MIXON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 OLD HINES RD
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-1165
Mailing Address - Country:US
Mailing Address - Phone:912-321-8368
Mailing Address - Fax:
Practice Address - Street 1:1113 E OGLETHORPE HWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-1200
Practice Address - Country:US
Practice Address - Phone:912-321-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223003163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health