Provider Demographics
NPI:1720373665
Name:MIXON, LYNDSAY JENKINS (ACNP)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:JENKINS
Last Name:MIXON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7407
Mailing Address - Country:US
Mailing Address - Phone:318-966-4541
Mailing Address - Fax:318-966-4543
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-966-4541
Practice Address - Fax:318-966-4543
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPENDING363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care