Provider Demographics
NPI:1013945997
Name:MIXON, CAROL RENEE' (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:RENEE'
Last Name:MIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:RENEE'
Other - Last Name:HAGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-7946
Mailing Address - Country:US
Mailing Address - Phone:828-389-8052
Mailing Address - Fax:828-389-8533
Practice Address - Street 1:1 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-7946
Practice Address - Country:US
Practice Address - Phone:828-389-8052
Practice Address - Fax:828-389-8533
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150853363LF0000X
GARN077261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000802062EMedicaid
NC5902096Medicaid
S41186Medicare UPIN
NC5902096Medicaid