Provider Demographics
NPI:1013506914
Name:MIXON, JOANNA RYAN
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:RYAN
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 1:652 BJ MIXON RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:36320-5062
Mailing Address - Country:US
Mailing Address - Phone:334-796-4590
Mailing Address - Fax:
Practice Address - Street 1:652 BJ MIXON RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AL
Practice Address - Zip Code:36320-5062
Practice Address - Country:US
Practice Address - Phone:334-796-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program