Provider Demographics
NPI:1245043942
Name:MIXSON, JAMEY
Entity type:Individual
Prefix:
First Name:JAMEY
Middle Name:
Last Name:MIXSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6267 WILSON MILLS RD # A-2
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2127
Mailing Address - Country:US
Mailing Address - Phone:440-566-0157
Mailing Address - Fax:
Practice Address - Street 1:6267 WILSON MILLS RD # A-2
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2127
Practice Address - Country:US
Practice Address - Phone:440-566-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach